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Objectives: Recruitment through Facebook is gaining favor as an approach for research, including clinical trials, because of the platform's ability to reach broad and diverse populations. As older adults increase their social media use, recruitment through Facebook has become a viable option. The purposes of this paper are to report the methodological process and lessons learned from recruiting custodial grandmothers (CGMs) for a cross‐sectional study examining parenting self‐efficacy and psychological well‐being. Participants: A total of 113 people consented and accessed the survey online, with 40 (35.4%) completing surveys. The final sample comprised 68 grandmothers, with 59% recruited via Facebook. Methods: Facebook recruitment for the online survey included creating a dedicated Facebook study page, accessing existing Facebook pages for custodial grandparents, and using paid advertising. Face‐to‐face recruitment strategies also were used with paper surveys. Results: We compared the characteristics of those completing online surveys versus paper surveys. CGMs completing the survey online were significantly younger and more likely to be Caucasian than those completing the paper survey. Conclusions: Findings indicated online recruitment via Facebook is an advantageous method to reach CGMs. However, additional research is needed to determine if other online and social media platforms would be useful in recruiting this population. [ABSTRACT FROM AUTHOR]

Objectives: Diabetes is a significant public health concern in India, with Kerala being labeled as the diabetes capital of the country. The study aims to evaluate the prevalence, treatment, and management of diabetes to examine the unmet need for care to propose cost-effective strategies. Design: A cross-sectional study was conducted on a geographically defined cohort population in Ernakulam. Sample: This paper presents diabetes data of adults ≥30 years enrolled from the community cohort. The interviews were conducted with 997 participants at their residence. Measurement: Random blood glucose was assessed for each participant using a finger prick test. Results: The overall prevalence of diabetes was 30.1%, of which 4.1% of participants had undiagnosed diabetes. Among those with diabetes, 86.3% were aware of their diagnosis; among those aware, 86.5% were on treatment. Among those on treatment for diabetes, 54% achieved controlled blood sugar. Conclusion: The challenge in diabetes management is controlling the blood glucose levels of people who adhere to treatment. Younger employed females from lower-income quartiles have the highest risk. The study also raises questions about quality and strategies for medication compliance. The findings inspire future research on care needs, policies, and program responses to reduce the diabetes disease burden. [ABSTRACT FROM AUTHOR]

Objective: Two percent of the Japanese population is comprised of foreign residents with further increase expected due to immigration policy revisions. The purpose of this paper is to examine the healthcare needs and difficulties experienced by foreign residents in Japan by level of their Japanese language fluency. Design: A quantitative, descriptive design was used. Sample: We surveyed foreign residents in the greater Tokyo area (N = 209). Measurements: The research team created the survey questions and the contents of the survey include foreign residents' experiences during their visits or stays at medical and public health facilities in Japan. Results: More than 90% of the participants or their families visited medical facilities in Japan regardless of Japanese language fluency; however, those with less Japanese language fluency experienced statistically significant uneasiness or inconvenience concerning communication compared to those with native Japanese language fluency (p =.000). Conclusions: Nurses in Japan may benefit from additional training related to use of interpreters as well as education about diversity and cultural humility. Through better understanding of the specific communication barriers of foreign residents, nurses will be able to better anticipate difficulties and address them. [ABSTRACT FROM AUTHOR]

Objective: Healthcare spending in the US is $3.2 trillion. $1.1 trillion is attributed to hospital care, including emergency department (ED) visits and hospitalizations. There is a relationship between ED utilization, hospitalizations, and health literacy in the general population. Health literacy may play a role in frequent ED visits and hospitalizations in patients with sickle cell disease (SCD). The purpose of this paper is to describe the relationship among health literacy levels, annual hospital encounters, annual clinic visits, annual ED visits, and annual hospitalizations in 134 Black, non‐Hispanic adolescents aged 10–19 years with SCD. Design: This is a cross‐sectional, descriptive correlational study evaluating facilitators and barriers to health literacy and clinical outcomes in adolescents with SCD. Sample: Data were collected from 134 Black, non‐Hispanic adolescents with SCD at a large, tertiary care center in Texas. Measurements: The Newest Vital Sign and REALM‐Teen health literacy instruments were used to evaluate health literacy. Results: Contrasting previous studies evaluating the influence of health literacy on ED visits and hospitalizations in the general population, there were no significant relationships within this sample. Conclusions: This study gives insight into future research to evaluate other potential influences on ED utilization and hospitalizations in pediatric patients with SCD. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: To adapt the Canadian Diabetes Risk Assessment Questionnaire for the Chinese population and to evaluate its psychometric properties. Design and Sample: A cross‐sectional study was conducted with a convenience sample of 194 individuals aged 35–74 years from October 2014 to April 2015. Methods: The Canadian Diabetes Risk Assessment Questionnaire was adapted and translated for the Chinese population. Test–retest reliability was conducted to measure stability. Criterion and convergent validity of the adapted questionnaire were assessed using 2‐hr 75 g oral glucose tolerance tests and the Finnish Diabetes Risk Scores, respectively. Sensitivity and specificity were evaluated to establish its predictive validity. Results: The test–retest reliability was 0.988. Adequate validity of the adapted questionnaire was demonstrated by positive correlations found between the scores and 2‐hr 75 g oral glucose tolerance tests (r = .343, p < .001) and with the Finnish Diabetes Risk Scores (r = .738, p < .001). The area under receiver operating characteristic curve was 0.705 (95% CI .632, .778), demonstrating moderate diagnostic value at a cutoff score of 30. The sensitivity was 73%, with a positive predictive value of 57% and negative predictive value of 78%. Conclusions: Our results provided evidence supporting the translation consistency, content validity, convergent validity, criterion validity, sensitivity, and specificity of the translated Canadian Diabetes Risk Assessment Questionnaire with minor modifications. This paper provides clinical, practical, and methodological information on how to adapt a diabetes risk calculator between cultures for public health nurses. [ABSTRACT FROM AUTHOR]

Objectives: To better understand the knowledge, practice, importance, awareness, usefulness, and confidence of non‐Hispanic Black and English‐ and Spanish‐speaking Hispanic/Latino adults with diabetes. Design: A descriptive cross‐sectional survey study design was used and descriptive statistics was conducted. Sample: Non‐Hispanic Black and Hispanic/Latino adults with diabetes were recruited from three New York City public hospitals. Measurements: A one‐time survey was delivered via email, text message or over the phone. Results: Of the 96 participants, 47.9% were Hispanic/Latino and 52.1% were non‐Hispanic Black individuals; 43.8% of the surveys were completed in Spanish and 56.3% in English; 41.7% were female and 58.3% male; 77.1% preferred to complete the survey via the telephone, 14.6% through email, and 8.3% via text message. Chi‐square findings showed, 90.6% knew mask wearing prevented COVID‐19; 96.9% knew that covering the nose and mouth during mask wearing is needed, 93.8% wore a mask, and 92.8% felt it important or very important to wear a mask to prevent the spread of COVID‐19. For social distancing, 88.5% knew it prevented the spread of COVID‐19, 93.8% practiced it, and 95.8% felt it important or very important. Conclusion: In having a better understanding of the knowledge and practices of COVID‐19 among non‐Hispanic Black and Hispanic populations with diabetes, the development of culturally and linguistically tailored community‐based mitigation strategies can be developed that are aimed at improving the preparedness of these groups for the next emerging infectious disease, such as COVID‐19. [ABSTRACT FROM AUTHOR]

Background: Dating apps for men who have sex with men (MSM) have favored unprotected sexual encounters; other unsafe practices, including drug use, are widespread. No evidence is available from the perspective of the structure of their relationships, a personal aspect included in all nursing meta‐paradigms. Aim: To study the structure of MSM networks through dating and contact applications and this relationship to risky sexual activities such as condom use, chemsex (sex while using drug), and group sex. Design: Descriptive cross‐sectional study. Sample: A total of 32 MSM participants from Madrid (Spain). Measurements: Socio‐demographic and structural variables with Social Network Analysis (SNA) metrics. Data on condom use, drug use during encounters, and group sex were included. Results: Twenty‐five percent of respondents practiced chemsex, and 75% of these used poppers. MSM with higher socioeconomic status participated in group sex sessions more frequently than those with lower socioeconomics. Within the network analysis, the relationships strong showed greater ease in having unprotected anal intercourse. Conclusion: SNA can be effective in the study of MSM sexual networks and their risk behaviors for community nurses to improve their interventions in sexual health promotion. [ABSTRACT FROM AUTHOR]

Objective: This study investigated the effects of occupational stress, anxiety, depression, and sleep disturbance on the level of fatigue among public health nurses (PHNs). Design: The study had a cross‐sectional, correlational survey design. Measures: A total of 198 PHNs were enrolled from 30 public healthcare centers/offices. Data were collected between May and July 2021 using a structured questionnaire to investigate the general characteristics, occupational stress, anxiety, depression, sleep disturbance, and fatigue of the participants. Descriptive statistics and multiple regressions were used to determine fatigue and its influencing factors among PHNs. Results: The participants showed high fatigue and occupational stress levels due to a lack of rewards. The percentage of participants with mild‐to‐severe anxiety and mild‐to‐severe depression, and those who identified themselves as poor sleepers were 44.9%, 50.5%, and 70.2%, respectively. High levels of sleep disturbance (β =.23, p <.001), occupational stress (β =.21, p <.001), anxiety (β =.20, p =.016), depression (β =.17, p =.043), being younger (β = –.15, p =.004), and being a regular worker (β =.13, p =.017) were influencing factors of fatigue. Conclusions: Individual efforts and organizational interventions to enhance sleep quality are needed to relieve fatigue among PHNs. Further, organizational support can be considerate of young nurses and regular workers, and alleviate their occupational stress. Moreover, anxiety and depression should be managed efficiently to reduce fatigue. [ABSTRACT FROM AUTHOR]

To describe experiences of student nurses and faculty who participated in COVID‐19 vaccine delivery through a multischool collaboration. Cross‐sectional survey. Student nurses and faculty members from five university schools and colleges of nursing who participated in one or more COVID‐19 vaccination or education events in 2021. Surveys were designed for students and faculty to document process and outcome experiences associated with project participation. Surveys were administered through an online survey platform. Overall, 648 students and 68 faculty members participated in the project. The evaluation survey was completed by 115 students (18%) and 58 faculty members (85%). Students valued increasing their clinical skills and reported the experience influenced their perspectives on nursing, fueling their passion and informing future career choices. Students reported that it was personally important to contribute to the vaccination effort. Few students reported challenges in participating in the project. Faculty reported positive experiences including gaining knowledge about public health and their communities, fueling their passion for nursing education, feeling a deeper connection with students, and experiencing personal satisfaction from contributing to the pandemic response. This project resulted in meaningful student learning opportunities, enhanced capacity for the public health emergency response, and strengthened partnerships among nursing programs and between academia and public health community partners. [ABSTRACT FROM AUTHOR]

Objective: To compare nurse and non‐nurse lead executives' relationship with organizational characteristics supporting performance and health equity in local health departments (LHD). Design: This was a cross‐sectional quantitative study. Sample: The final national sample consisted of 1447 LHDs using the 2019 Profile of Local Health Departments survey. Measurements: We used multivariable logistic and negative binomial regression analyses to explore the relationship between nurse versus non‐nurse LHD lead executives and involvement in ten organizational characteristics including community health assessment (CHA) and community health improvement plan (CHIP) completion and policy activities related to the social determinants of health (SDOH). Results: Multivariable logistic regression models showed that, for nurse lead executives, the odds of having completed a CHA is 1.49 times, and the odds of having completed a CHIP is 1.56 times, that of non‐nurse lead executives. Negative binomial regression models predicted nurse lead executives, compared to non‐nurses, to perform 1.18 times more SDOH‐related policy activities. Conclusion: Results suggest that nurse lead executives are more likely than non‐nurses to emphasize assessment in their work and engage in upstream‐focused policy activities. As such, they are important partners in work to facilitate health equity. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study is to explore the association between economic wellbeing and ethnicity, socioeconomic status, and remoteness during the COVID‐19 pandemic. Design: A cross‐sectional study via SurveyMonkey was conducted in Australia between August 2020 and October 2020. Descriptive and inferential statistics were used to analyze the data. Results: A total of 1211 individuals responded to the survey. Income loss was significantly associated with those from low socioeconomic status (OR = 1.65; 95% CI 1.01–2.68). Access of superannuation was significantly associated with those in outer regional (OR = 3.61; 95% CI 0.81–16.03) and low socioeconomic status (OR = 2.72; 95% CI 1.34–5.53). Financial inability to pay for services was significantly associated with living in remote areas (OR = 2.26; 95% CI 0.88–5.80). Conclusions: The economic wellbeing of people who identify as Aboriginal and Torres Strait Islander, live in regional or remote areas, and reside in low socioeconomic areas have been substantially impacted during the pandemic. Findings call for policies to address the underlying social determinants of health. [ABSTRACT FROM AUTHOR]

Objective(s): To explore the perceived threats of COVID-19 and how it changed the personal hygienic precautionary behaviors across multiple countries in the Middle East and North Africa (MENA) region. Design: A cross-sectional descriptive design was used to survey the four targeted MENA countries: Jordan, Palestinian territories, Saudi Arabia, and Egypt. Sample: A nonprobability convenience sampling design was utilized. The link to the survey questionnaire was distributed through social media groups within Facebook® and Twitter®. The groups are known and accessible by known across the general population at the targeted countries. Measurement: Data was collected using The Brief Illness Perception Questionnaire and an adapted instrument that examine the hygienic precautionary behaviors during COVID-19 pandemic. Results: Answers of participants (n = 2604) were valid and included in the study. The results show that a minimal perception of threat among the participants on most of the BIP-Q5 items (M = 12.9, SD = 7.2). Moreover, the highest compliance rates to recommended hygienic precautionary behaviors were found among populations above the age of 50 years (F = 2.89, p = .04), females (t = 5.18, p = .003), being married (F = 3.09, p = .029), and being a health care professional (t = -2.20, p = .028). Conclusion: The perceived threat of COVID-19 and compliance rates with the recommended hygienic precautionary behaviors among Arab societies were found to below and need critically urgent attention. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to explore healthcare providers’ (HCP) stigmatization from patients during the COVID-19 outbreak in Jordan. Method: A cross-sectional design was used. Data collection was conducted between May and July 2021. The research questionnaire included demographic information about participants and multiple statements that reflect stigma of participants toward HCPs. Regression analysis was conducted to assess the association between stigma and explanatory variables. Results: A total of 777 surveys were included in the study. Many people show high stigma toward HCPs during COVID-19 pandemic. Various factors including hearing news all time (p<.001), having children (p<.024), and smoking (p<.001) were significant in prediction stigma toward HCPs. Conclusion: This one of few studies conducted in Jordan regarding the stigma toward HCP from other people with chronic diseases. Our study found that many people showed some stigma toward HCP during COVID-19. Stigmatization of HCP related to a pandemic is a lesson most people have not learned. It is not enough to cheer HCPs. A clear, sensible public education campaign about the public’s risks by interacting with HCP is necessary. [ABSTRACT FROM AUTHOR]

The coronavirus outbreak threatens global well‐being, costing thousands of lives and an unstable economy. Traditional hand‐washing (HaWa) with clean water and hand‐washing sanitizers (HaWaSas) are among WHO recommended practices against the outbreaks. HaWaSa and HaWa lacked proper quality monitoring evaluation that may pose health risks. The current study investigates the potential of traditional hygienic practices adopted to mitigate the 2019–2020 Pandemic. It involved assessing the effectiveness of 15 HaWaSa collected from the Dodoma market. Thirty volunteered participants were subjected to different hygienic practices involving HaWa and HaWaSa. The obtained hand‐swabbed samples were subjected to the streak plate technique for inoculation, followed by counting colonies. The results revealed that, among the collected HaWaSa brands, only 33.3% were certified by the Tanzania Bureau of Standards (TBS). In the setting under no hand‐wash, each client had a different number of colony counts. HaWa did not eliminate all colonies since water acted as a secondary source while only one sanitizer proved effective. The p‐values obtained in either setting were greater than 0.05, indicating that each variable was independent. Despite global awareness and fighting against the Coronavirus Disease 2019 (Covid‐19) outbreak, quality monitoring of all diagnostic tools, preventive HaWaSa, and related drugs should be prioritized for human safeguard. [ABSTRACT FROM AUTHOR]

Objective: To understand communities' perceptions, beliefs, and health‐related behavior choices related to COVID‐19 in order to guide public health nursing communication and interaction with patients and the community. Design: A qualitative study, guided by the Health Belief Model (HBM), strove to comprehend the perceptions and reactions to COVID‐19 among Wisconsinites. Sample: Twenty‐five diverse Wisconsin residents aged 18 or older. Measurements: Semi‐structured interviews provided information about individuals' attitudes, perceptions, and reactions to COVID‐19. Interviews were audio‐recorded, transcribed, and thematic analysis was conducted to identify themes. Results: We identified three major themes: (1) "health care starts way before you ever enter the doors of a healthcare facility"; (2) "to live in a society is to help each other"; and (3) mental health as impacted by COVID‐19. Conclusions: This study demonstrated the need for greater public health support, as well as the role of Social Determinants of Health. Understanding perceptions and reactions to COVID‐19 can help public health nurses understand and better respond to future pandemics. [ABSTRACT FROM AUTHOR]

Objective: To analyze the impact of the foot health and health behavior and the characteristics of outdoor footwear among minority ethnic groups. Design and measures: A cross‐sectional study design using the Foot Health Status Questionnaire: foot pain, foot function, shoe, general foot health, general health, physical activity, social capacity, and vigor. Outcomes included the self‐reported type of outdoor footwear and clinical characteristics by sex were collected in 2019–2020. Sample: A total of 78 Roma participants self‐identified as members of this ethnic minority and 72 participants non‐Roma were assessed (n = 150). Results: The lower score values was recorded in the footwear and general foot health domains in Roma population. General population obtained higher scores in general health domains. The most common outdoor footwear types were running shoes and walking shoes in non‐Roma population, versus flip flops and slippers in Roma population. Clinical characteristics did not show any statistically significant differences (p <.05). Conclusion: Roma people wear flip flops and slippers and non‐Roma people running shoes and walking shoes. These findings reveal cultural differences that make it easier for the Roma population to experience a greater burden of foot health problems. General foot health and foot pain dimensions show statistically significant differences among ethnicity. [ABSTRACT FROM AUTHOR]

Design: A cross‐sectional study was conducted in December 2020/January 2021 in the five significant cities of Germany. Sample: 135 of 244 identified service institutions took part in the evaluation. Measurements: This evaluation included changes in institutions' operating hours as well as capacity for homeless people. Service institutions described changes in guests' characteristics, moods, and mental burden. Finally, equipment including face masks, coveralls, and gloves was investigated. In addition, the study examined how the cooperation with the health authorities works. Results: Institutions reduced their operating hours and capacity for guests (62.4%). Increased costs, which they had to cover themselves, were reported by 70.9% of institutions. Institutions reported, that guests showed more symptoms of aggression (15%), anxiety (25%), and desperation (32%) and fewer signs of being relaxed (75%). The institutions reported room for improvement in PPE supplies and collaboration with health authorities. Conclusions: Services are limited for a vulnerable population, which shows changes in moods and mental health. Health authorities are not sufficiently engaged to take over the role of institutions in caring for homeless people. In the future, in‐depth investigation to improve this is necessary. [ABSTRACT FROM AUTHOR]

States across the country have been experiencing a steady decline in public health nursing workforce, including North Carolina (NC). Objectives: To better understand retention in the NC Public Health Nurses (PHNs) workforce through an assessment of perceptions of the working environment, stress, intent to stay, and job satisfaction. Design: A cross‐sectional online survey using closed and open‐ended questions. Sample: The study population comprised of non‐supervisory PHNs (n = 672) working at NC local health departments (LHD). Measurements: Retention problem, working environment, and job satisfaction measures were adapted from the revised Casey‐Fink Registered Nurse Retention Survey© (2009) to fit public health settings. Results: Despite high levels of job satisfaction (79.76%, n = 473), 53% of respondents (n = 323) acknowledged a retention problem within their LHD; 35.32% (n = 203) planned to/considered leaving their position in the next 3 years for reasons other than retirement. ANOVAs and Kruskal Wallis Test results showed that those planning to leave had statistically lower scores on perceived working environment and job satisfaction and demonstrated higher negative stress levels. Conclusion: Like other states, NC is experiencing a PHN shortages predicted to worsen in coming years. To retain the current workforce, LHDs need to work to improve PHNs working environment, increase PHNs' pay, and alleviate stressors. [ABSTRACT FROM AUTHOR]

Objectives: Healthcare workers (HCWs) are considered an important target group for the COVID‐19 vaccines. The current study assesses the knowledge and attitudes of Israeli HCWs regarding COVID‐19 immunization, and how various occupational and demographic factors may underlie COVID‐related knowledge and attitudes differences. Methods: Following a pre‐test to validate measures, a cross‐sectional online anonymous survey was distributed to HCWs using a snowball sampling method. Results: The survey was completed by 714 participants (mean age 39.9; range 18–74; 447 female), 52% doctors, 32% nurses, and the remainder by paramedical staff. Of the respondents, 553 (77.4%) answered the question are you in favor of getting the COVID‐19 vaccine, 105 (14.7%) were not sure, and 56 (7.8%) were not in favor. Doctors had higher odds of agreement as compared to both nurses (p <.025) and paramedical staff (p <.001). Multivariate logistic regression analysis revealed that increased age (OR: 1.075; 95% CI: 1.04–1.11, p <.001), profession (physician vs. nurse; OR: 2.73; 95% CI: 1.32–5.65; p <.007), and getting the current influenza vaccine (OR: 4.96; 95% CI: 2.47–9.95) were significant predictors of agreement. Conclusions: A high level of HCWs knowledge and in favor attitudes were observed. Yet negative attitudes were also noted, particularly among nurses, paramedical staff, and young employees. [ABSTRACT FROM AUTHOR]

Objectives: This study sought to (1) determine the number of persons evicted from the Durham Housing Authority (DHA) over a 5‐year period, (2) explore changes in the number of persons with various medical diagnoses and health care utilization patterns before and after eviction, and (3) examine how many persons evicted from DHA became literally homeless. Design: This was a pre/post cross‐sectional quantitative study. Sample: Heads of households evicted from DHA properties from January 1, 2013 through December 31, 2017 were included in the study. Measurements: We matched people evicted by the DHA in a university health system electronic health record system to determine changes in diagnoses and health care utilization before and after eviction. We also matched the cohort in the homeless management information system to determine how many persons evicted became literally homeless. Results: Findings indicate statistically significant increases in persons with medical diagnoses in five of ten categories, total hospital admissions, and emergency department visits after eviction. Of the 152 people included in the study, 34 (22%) became literally homeless. Conclusions: Health and health care utilization patterns were different before and after eviction. Implications for clinicians are explored. [ABSTRACT FROM AUTHOR]

Objectives: To translate, cross‐cultural adapt and psychometrically validate the Children's Environmental Health Knowledge Questionnaire (ChEHK‐Q) and the Children's Environmental Health Skills Questionnaire (ChEHS‐Q) for community nurses in China. Design: This was an observational, cross‐sectional study undertaken in two phases: (1) translation and cultural adaptation process; (2) psychometric evaluation. Sample: A total of 294 nurses from 23 community health service centers in cities of Henan province participated in the study. Methods: These two questionnaires were analysed psychometrically based on IRT. ChEHK‐Q was analyzed based on basic Rasch Model, and ChEHS‐Q based on Rating Scale Model (RSM). EFA, expert validity, threshold analysis, retest reliability, item and individual reliability were used to evaluate the psychometric attributes of these two questionnaires. Results: The Infit and Outfit values for most items are within reasonable limits. The person reliability of ChEHK‐Q was 0.85 and the item reliability was 0.97. The person reliability of ChEHS‐Q was 0.94 and the item reliability was 0.93. The test‐retest reliability of the ChEHK‐Q was 0.85 and the ChEHS‐Q was 0.87. Conclusions: ChEHK‐Q and ChEHS‐Q are reliable and valid instruments with satisfactory psychometric properties for nurses in China. Future studies should recruit a more representative sample to verify the applicability of these two questionnaires. [ABSTRACT FROM AUTHOR]

Objective: To explore the current practice and perceptions of health visitors in supporting multiple birth families. Design and sample: Practicing health visitors across the United Kingdom were invited to complete a cross‐sectional, descriptive, online survey. The questionnaire covered multiple birth caseload, education received about multiples and the experience of working with families. Two‐hundred and ninety health visitors completed the questionnaire. Descriptive and inferential statistics were used for analysis of the quantitative components and thematic analysis for the qualitative data. Results: Most health visitors had twins on their current workload. Most health visitors had not received any specific training or continuing professional development regarding the needs of multiple birth families. Supporting the families within the confines of reduced time and increased workload was challenging. Daily tasks of caring for multiples were the main areas that health visitors and parents wanted more information about. Conclusions: In the United Kingdom, health visitors are uniquely positioned to support multiple birth families, in particular during the more challenging early years. However, the findings of this study suggest that many health visitors are aware that the care and support that they are able to provide multiple birth families falls short of meeting their needs [ABSTRACT FROM AUTHOR]

Objective: To conduct a community health needs assessment among the Hispanic faith community population to develop a community‐partnered research agenda. Design: A cross‐sectional design was used to conduct a community needs assessment using a community‐based participatory research approach Sample: Hispanic faith community members in Central Arkansas. Measurement: Data collection was led by Hispanic faith leaders using an audience response system at places of worship. An 88‐item Community Health Needs Assessment survey was used that included demographic questions and questions related to five domains including community concerns, community resources, healthcare access, health concerns, and hunger and nutrition. Results: There were a total of 100 participants in the community needs assessment. Hunger and nutrition was the highest ranking community concern followed by healthcare access. Conclusion: Based upon the results of the study, the university researchers and Hispanic faith community members have begun the initial steps to developing a research agenda to address the major concerns of the community. [ABSTRACT FROM AUTHOR]

Almost half of all pregnancies (45%) in the United States (US) are unintended, with the highest concentration in women with low incomes. Targeted research is warranted to identify risk and protective factors that influence pregnancy intention to improve maternal/child health. Purpose: To identify individual and interpersonal level associations to pregnancy intention to use as leverage points to build resilience. Method: A cross‐sectional, secondary analysis of Medicaid eligible pregnant women in Kentucky (n = 309). Results: Sixty‐two percent reported their current pregnancy was unintended. Older age, partnered, negative drug screen, and increased social support were associated with decreased odds of unintended pregnancy. For every 1 unit increase of belonging and tangible social support, women were 13% and 14% (respectively) less likely to have an unintended pregnancy (OR = 0.87, 95% CI = 0.78–0.97, p =.011, OR = 0.86, 95% CI = 0.77–0.95, p =.005). A positive drug screen was associated with an almost three‐fold increase in the odds of unintended pregnancy (OR = 2.88, 95% CI = 1.49–5.58, p =.002). Conclusion: Public health nurses can play a critical role in reducing unintended pregnancy rates by promoting social support, inclusion, and acceptance. There remains a critical need to identify barriers and facilitators to pregnancy planning for persons who use illicit drugs. [ABSTRACT FROM AUTHOR]

Objective: The study examined the impact that the Medicaid expansion in Illinois had upon insurance rates, access to medical care, dental care, pharmaceuticals, and mental‐health counseling between rural and urban counties. Design and Sample: A serial cross‐sectional design was used to assess the health perceptions of adults living in Illinois. Measures: Survey data were collected in 2012 (n = 6,149) before the Medicaid expansion in Illinois and in 2015 (n = 3,532) after the expansion from rural (n = 4) and urban counties (n = 4). Intervention: Medicaid expansion reduced the uninsured rate in both rural (16.39%–4.87%) and urban counties (17.05%–5.2%) and improved self‐reported health. It also increased access to all types of healthcare, with the biggest increase in dental coverage. Results: Path analysis indicated that the Medicaid expansion β = −1.03 (p <.01) and poor versus not poor β = −1.50 (p <.01) were a significant predictor to no healthcare access. Rural verses urban location was not significant (β = 0.04); however, race/ethnicity was significantly different (p <.01). Conclusion: Findings suggest that although the expansion has increased access to care overall, those who are the most vulnerable are still not benefiting equally from the expansion. Therefore, strategies to assist high‐risk adults in enrolling and using their Medicaid coverage need to developed and implemented. [ABSTRACT FROM AUTHOR]

Objectives: This study was conducted to develop and evaluate a theoretical model to explain the relationships among participation in individual and social activities, compliance with prevention guidelines, and the perception of fatalism and fear of COVID‐19. Methods: Cross‐sectional survey of 1,067 participants who were >18 years of age living in different provinces of Turkey recruited between August 15, 2020 and October 15, 2020. We used covariant structural analysis to assess the relationships of the constructs of the theoretical model. Results: Significant fits were detected for Model 1 (χ2 = 924,389, p <.001, comparative fit index or CFI = 0.944), and for Model 2 (χ2 = 2,253,751, p <.001, CFI = 0.926). The predetermination and luck subdimensions reduce the fear of COVID‐19, while the pessimism subdimension and compliance with preventive measures increase the fear. Conclusion: In public health crises such as COVID‐19, it is important to plan scientific knowledge‐based public education; take initiatives in accordance with the cultural, social, economic, religious, and local characteristics of the societies; and conduct public health studies covering the whole society. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to describe the levels of illness perception and identify interrelations among the variables of illness perception, demographic, and health‐related characteristics in a sample of rural Chinese adults with hypertension (HTN). Design: This is a cross‐sectional descriptive study using descriptive and correlation analysis. Sample: It included 163 people diagnosed with HTN for at least 3 years who lived in two rural villages in Zhejiang Province of mainland China during 2014–2015. Measurements: Illness perception was measured by the Chinese Illness Perception Questionnaire‐Revised. Demographic and illness characteristics were collected by the researcher. Weight, height, and blood pressure (BP) were, respectively, measured by calibrated scale and digital sphygmomanometers. Results: The findings showed that the BP control rate was 28.80% in the village. The highest average item score found in timeline (3.98 ± 0.76) and control (3.29 ± 0.67) subscales indicated that rural Chinese adults believe in the chronicity and controllability of HTN. Negative illness representation presented the lowest mean item score (2.64) suggesting that the participants neither perceive symptom variation of the illness nor their illness as serious. Interrelations existed among the illness perception variables with variation from that in other previous study. The cause of HTN was attributed to balance factors, psychological factors, risk factors, and cultural factors in sequence. Age, education, body mass index, and household annual income were correlated with illness perception. Conclusion: These findings suggested that misconceptions about HTN perception existed among rural adults in the villages. Comprehensive health education program is needed to increase rural adults' knowledge and management of HTN. [ABSTRACT FROM AUTHOR]

Objective: This study examined whether cigarette smoking mediated the association of racial discrimination with depressive symptoms among pregnant Black women. Design: Cross‐sectional. Sample: Two hundred Black women at 8–29 weeks gestation. Measurements: Women completed questionnaires including the Experiences of Discrimination and the Center for Epidemiologic Studies‐Depression (CES‐D) scales, as well as questions about sociodemographic characteristics and cigarette smoking. Results: The mean age of the sample was 26.9 ± 5.7 years and the mean gestational age at data collection was 15.6 ± 5.7 weeks. Approximately 17% of women reported prenatal cigarette smoking; 27% had prenatal CES‐D scores ≥23, which have been correlated with depression diagnoses; and 59% reported ever (lifetime) experiencing discrimination in at least one situation (e.g., at work). Path analysis results indicated that the standardized indirect effect of experiences of racial discrimination on CES‐D scores through prenatal smoking was statistically significant (standardized indirect effect = 0.03; 95% CI: 0.001, 0.094; p =.042). Conclusion: Cigarette smoking during pregnancy partially mediated the association between lifetime experiences of racial discrimination and prenatal depressive symptoms among pregnant Black women. Smoking cessation programs should focus on identifying and treating depressive symptoms among pregnant Black women. [ABSTRACT FROM AUTHOR]

Objective: Community reentry post‐incarceration is fraught with challenges. The investigators examined the influence of highly personalized goals (possible selves) on psychological well‐being, drug use, and hazardous drinking in recently incarcerated young men returning to the community. Design and Sample: In this cross‐sectional study, 52 young men released from jail or prison within the past 12 months were recruited from community‐based organizations and reentry events. Measurements: Participants completed open‐ended possible selves measure and psychological well‐being and substance use questionnaires. Results: Possible selves accounted for 19%–31% of the variance in sense of purpose, environmental mastery, and personal growth. Having a feared delinquent possible self was associated with lower sense of purpose. Having many feared possible selves was associated with lower environmental mastery. Having an expected possible self related to interpersonal relationships was associated with higher personal growth and environmental mastery. Men having a feared delinquent possible self or an expected possible self related to material/lifestyle were more likely to use marijuana than men who did not. Conclusion: The content and number of possible selves may be an important focus for assessment by public health nurses in correctional and community settings serving young men post‐incarceration. Longitudinal studies with larger samples are needed. [ABSTRACT FROM AUTHOR]

Purpose: From 2009 to 2019, more than 175,000 refugees were admitted into the United States from African countries. What is known about sexual and reproductive health in this population is focused on perinatal outcomes; beliefs and attitudes towards family planning and related behaviors, which can impact perinatal health, have not been explored. Understanding these beliefs and attitudes can guide future work with this population. Study Design: A cross‐sectional, convenience survey of 100 community‐dwelling African refugee women was conducted. Results: The following research questions guided analysis: What are African refugee women's family planning attitudes (pregnancy intention, desired timing, perceived fecundity)? What are African refugee women's family planning behaviors (use vs. non‐use of methods, type of methods used)? and What socio‐demographic factors and family planning attitudes are related to family panning behaviors (use or non‐use of methods)? Almost 49% of participants reported ever using a method of family planning and 35% reported current use. Reasons for non‐use included desire for more children (28.8%), infrequent intercourse (22.0%), and fear of side effects (16.9%). Nearly two thirds expressed a desire for a future pregnancy (63.4%), but the majority reported wanting to become pregnant in two or more years (25.7%) or "when God wants" (24.8%). No significant relationship was found between family planning method use and future pregnancy intention, desired timing of future pregnancy, perceived fecundity, marital status, religious affiliation, number of years in the US. Having had any formal schooling decreased the likelihood of using a family planning method. Implications for Practice and Research: Low family planning method use rates among African refugee women are not completely explained by desires for future pregnancy, perceived fecundity, marital status, or other sociodemographic factors. Concern for future fertility and fear of side effects were identified as potentially modifiable reasons appropriate for community based culturally congruent educational interventions on family planning use. [ABSTRACT FROM AUTHOR]

Objective: A collaborative research team of community/public health nursing faculty and public health nurses surveyed public health nurses to explore knowledge, skills, attitudes, and application of the Quad Council Competencies for Public Health Nurses (QCC‐PHN). Methods: Evaluate the knowledge, skills, attitudes, and application of the 2011 QCC‐PHN by public health nurses. Design: A descriptive, cross‐sectional design was used to answer the hypothesis related to the study objective. A convenience sample of 308 public health nurses completed an online survey. Measurements: ANOVA was used to determine the difference between the knowledge, skills, attitudes, and application of community/public health nurses (C/PHNs) regarding the QCC‐PHN based on nursing specialty preparation, years of nursing experience, and years of C/PHN experience. Results: C/PHNs are described and differences in knowledge, skills, attitudes, and application are delineated. A statistically significant difference was found in knowledge and attitude based upon years of C/PHN experience. Conclusions: Recommendations are proposed for increasing the QCC‐PHN awareness, implementation, and evaluation to effectively enhance the practice of nursing C/PHN. [ABSTRACT FROM AUTHOR]

Objective: This descriptive study examined the prevalence and correlates of trauma, substance use, and mental health symptoms in homeless transitional age youth (TAY) in San Francisco. Design & Sample: One hundred homeless TAY were recruited from a community‐based organization to complete a survey on trauma, mental health symptoms, and substance use. Measurements: We used these measures: National Institute on Drug Abuse (NIDA)‐Modified Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) for frequency and risk level of substance use; the 10‐item Adverse Childhood Experiences (ACEs) for prevalence of trauma; the Post‐traumatic Stress Disorder Checklist for DSM‐5 for post‐traumatic stress disorder (PTSD) symptoms; Center for Epidemiologic Studies Depression Scale for depression symptoms; and Generalized Anxiety Disorder 7‐item for anxiety symptoms. Results: Almost all (n = 98) participants experienced at least one ACE during childhood, and 77% experienced four or more. Most participants (80%) reached the diagnostic threshold for PTSD, 74% for depression, and 51% for moderate anxiety. Symptoms of PTSD, anxiety, and depression were all significantly correlated with use of opioids and stimulants. Conclusion: Trauma, and co‐occurring substance use and mental health problems are prevalent among homeless TAY. Individual‐ and community‐level interventions are needed to address and improve the health of this population. [ABSTRACT FROM AUTHOR]

Background: Transgender women of color (TWC) are an underserved population who often experience high rates of HIV and barriers to care including stigma, violence, and trauma. Few health information technology interventions are tailored to serve TWC. The purpose of this study was to inform the development of a TWC‐specific telehealth intervention to increase access to care. Methods: Formative qualitative semi‐structured interviews and focus groups were conducted to develop a customized telehealth intervention for TWC. Participants were TWC ≥ 18 years living in the Washington, DC metropolitan area, with at least one structural barrier to care and clinicians ≥18 years who provide care to TWC. Transcripts were analyzed using thematic coding and content analysis; barriers for TWC were categorized into Individual, Organizational, and Environmental levels. Several day‐long meetings with TWC and stakeholders were convened to develop the intervention. Results: Saturation of theme on barriers to care was reached with 22 interviews. Identified barriers to service receipt included survival, instability, temporal discounting, and prioritizing hormone therapy over care, incongruence between providers and patients, pessimism, and lack of cultural competency. Each was intentionally addressed with the telehealth intervention. Conclusions: Data informed the development of an innovative and customized telehealth intervention for TWC. Through the integration of technology and peer consultant outreach, we developed a novel approach that can address population‐specific challenges to care. Further development of this model may be able to improve health outcomes among TWC. [ABSTRACT FROM AUTHOR]

Objective: The purpose was to compare nurse education, patient‐to‐nurse staffing, nursing skill mix, and nurse work environments across hospitals depending on extent of rurality. Design: Cross‐sectional, comparative, and descriptive. Sample: The final sample included 566 urban, 49 large, 18 small, and 9 isolated hospitals from California, Florida, and Pennsylvania. Measurement: Data collected from large random samples from the 2005–2008 Multi‐State Nursing Care and Patient Safety Study funded by the National Institute of Nursing Research and National Institutes of Health were linked to 2005–2006 American Hospital Association data. Rural–Urban Commuting Area codes developed by the University of Washington and the United States Department of Agriculture Economic Research Service were used to determine the extent of hospital rurality across the sample. Results: Hospital percentages of baccalaureate prepared nurses differed significantly among urban (38%), large (28%), small (31%), and isolated rural hospitals (21%). Patient‐to‐registered nurse ratios in urban (4.8), large (5.6), small (5.6), and isolated rural hospitals (7.3) differed. Rural hospital nursing skill mix differed, and was lowest in isolated rural hospitals (65%). Nursing foundations for quality care were poorer in large, small, and isolated rural hospitals. Conclusion: Results support bolstering rural nursing resources in more remote locations, potentially through rural health policies. [ABSTRACT FROM AUTHOR]

Objective: This study was aimed to assess the willingness to receive prenatal influenza vaccine and explore its associated factors among pregnant women in Taiwan. Design and Sample: The study population included pregnant women who received prenatal care from five private hospitals/clinics during 2017–2018 influenza season. Measurements: Collected data, including demographics, health‐relevant factors, as well as knowledge and attitudes regarding influenza and its vaccine, were analyzed using chi‐square tests, Fisher's exact test, and multivariate logistic regression analysis. Results: A total of 498 pregnant women completed the questionnaires, 321 (64.5%) intended to receive prenatal influenza vaccine. Among those who were unwilling to be vaccinated, most (88%) had concerns about the adverse events of the vaccine. Four factors were independently associated with willingness, including hospital/clinic (aOR=6.57, 95% CI=1.96–22.04), previous influenza vaccination history (aOR=9.44, 95% CI=5.63–15.83), knowledge (aOR=2.64, 95% CI=1.25–5.55) about, and attitude (aOR=5.99, 95% CI=2.40–14.92) toward influenza vaccination. Conclusions: Pregnant women with insufficient knowledge, negative attitudes, or no experience of influenza vaccination, and in remote areas were less willing to receive maternal influenza vaccine. The adverse events and uncertainty regarding the safety of vaccines were the most important factors. The health‐care providers should promote or explain risks and benefits of maternal influenza vaccination during prenatal care or outpatient consultation. [ABSTRACT FROM AUTHOR]

Objectives: This study was conducted to determine refugee women's attitudes towards family planning and related factors. Design and Sample: Designed in descriptive and cross‐sectional type, the study involved 555 voluntary Syrian refugee women in Turkey. Measures: A questionnaire and the Family Planning Attitude Scale (FPAS) were used. Independent Sample T test, ANOVA test, and Pearson's correlation analysis were used for data analysis. Results: A significant association was found between the average FPAS scores with educational status, income level, social security, use of FP methods, spousal support for FP, and training for FP in Syria. Conclusions: It was determined that the attitudes of women towards family planning were at the medium level, nearly half of them used a kind of family planning and received its training, and that their attitudes towards family planning were affected by their and their husband's educational level, their income level, the availability of social security, the type of family planning, the utilization of family planning, and spousal support. Based on our study findings, refugee women and their partners/husbands should be informed on FP and their attitudes towards and the barriers against FP should be investigated by further studies. [ABSTRACT FROM AUTHOR]

Objective: The study was conducted to develop a theoretical model to comprehensively explain suicidal ideation in Korean college students by including resilience, belongingness, and college life adjustment in addition to depression and stress. Design and Sample: This study was a descriptive survey with 291 college students. Measures: Structural equation modeling was used to the hypotheses on this study. Results: Belongingness and depression showed a statistically significant direct effect, and college life stress and belongingness showed a statistically significant indirect effect. Belongingness was the most influential, and all the predictors in combination had an explanatory power of 37% for suicidal ideation in college students. Conclusions: Findings suggest a model of suicidal ideation focused on perspective, protective factors; previous research provided a negative perspective with focus on risk factors for suicidal ideation. Findings can be used to develop diverse programs to decrease suicidal ideation in college students and help them to adjust to college life. [ABSTRACT FROM AUTHOR]

Background: The Indian national program stresses implementation of cervical cancer screening by health workers/nurses using VIA (Visual Inspection under Acetic acid). We demonstrate its feasibility and reliability in rural setting, assessing the role of smartphone‐imaging for continuous training of nurses. Design: A cross‐sectional design to assess the reliability of the nurse‐led VIA test. To assess feasibility, VIA positive patients were observed till confirmative diagnosis was made. Sample: Hospital‐based purposive sampling was used to recruit participants. Measures: A structured questionnaire for recording participants' details, VIA findings and follow‐up information; and an observational checklist to record implementation parameters during each clinic. An expert assessed the nurse's judgment using smartphone‐images of cervix. Results: During October 2016–June 2017, 2758 patients attended the weekly clinic; 238 (8.6%) met the criteria, of those 180 (75.6%) tested after consent. Nurse reported 25 (13.8%) VIA‐positive cases, but only 19 accessed the referral service. Kappa statistic: 0.45 (CI: 0.26‐0.63) suggested moderate nurse‐expert agreement. Image retrieval and quality affected expert's evaluation. Implementation challenges include low awareness among the population and referral link‐up. Conclusion: Appropriately trained nurses can reliably conduct screening. Real‐time expert feedback might improve reporting. Rigorous awareness activities and on‐site treatment can reduce drop‐outs. The medical institute's involvement and administrative will were instrumental. [ABSTRACT FROM AUTHOR]

Objective: To assess the factors influencing the attitudes of Bachelor of Science in Nursing students toward climate change and environmental sustainability and the inclusion of these concepts in the nursing curricula of four Arab countries. Method: A convenience sample of 1,059 students from four Arab countries was surveyed using the Environmental Sustainability Attitudes in Nursing Survey‐2 (SANS‐2) questionnaire in this descriptive‐comparative study. Results: The majority of the respondents exhibited positive attitudes toward the five items of SANS‐2, with "Environmental sustainability is an important issue for nursing" receiving the lowest mean score and "Issues about climate change should be included in the nursing curriculum" receiving the highest mean score. Saudi students had more positive attitudes toward environmental sustainability in health care compared with students from Iraq, Egypt, and the Palestinian Territories. Country of residence, type of community, and knowledge about environmental issues and their impact on health in any nursing course were significant factors that influenced attitudes toward environmental sustainability. Conclusion: The inclusion of climate change and environmental sustainability in nursing curricula in the Arab region was emphasized by the findings. Including environmental sustainability practices in nursing education will help student nurses develop critical thinking and skills in the adaptive delivery of health care, especially when resources are scarce. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To model condom usage by jail‐incarcerated women incarcerated in US local jails and understand results in terms of fundamental cause theory. Design, Sample, Measurements: We surveyed 102 women in an urban jail in the Midwest United States. Chi‐square tests and generalized linear modeling were used to identify factors of significance for women who used condoms during last sex compared with women who did not. Stepwise multiple logistic regression was conducted to estimate the relation between the outcome variable and variables linked to condom use in the literature. Results: Logistic regression showed that for women who completed high school odds of reporting condom use during last sex were 2.78 times higher (p = .043) than the odds for women with less than a high school education. Among women who responded no to ever having had a sexually transmitted infection, odds of using a condom during last sex were 2.597 times (p = .03) higher than odds for women who responded that they had had a sexually transmitted infection. Conclusions: Education is a fundamental cause of reproductive health risk among incarcerated women. We recommend interventions that creatively target distal over proximal factors. [ABSTRACT FROM AUTHOR]

Abstract: Background: Although cancer incidence and mortality is declining, cancer remains among the leading causes of death in the United States. Research shows that cancer morbidity and mortality can be reduced by early detection. Yet, both cancer risks and screening behavior remain understudied in the homeless population. Methods: Researchers conducted a cross‐sectional survey of homeless individuals (n = 201). The analysis describes the demographic, psychosocial, and behavioral associations with cancer screenings and knowledge of the lung cancer screening recommendation. Results: Participants’ mean age was 51.7 years (SD 13.6); the group was largely African American (77.3%) and male (67.9%). Among women, the breast and cervical cancer screening rates were 46.5% and 85.1%. Among men the prostate cancer screening rate was 34.2%. Among all participants, the colon cancer screening rate was 44%. Cancer risk behaviors were high. Lung cancer screening knowledge was low (23.0%). Some cancer screening behaviors were associated with age, income, health status, obesity, tobacco use, and physical activity. Discussion: Despite higher cancer risk behaviors, knowledge and general participation rates for cancer screenings were below national benchmarks. Conclusion: To improve cancer survival among disparate populations, sustained community outreach is necessary to increase awareness of screening recommendations, identify high‐risk individuals, and navigate them to resources. [ABSTRACT FROM AUTHOR]

Abstract: Objective: This study is the first community engagement phase of a project to develop a residential formaldehyde detection system. The objectives were to conduct a feasibility assessment for device use, and identify factors associated with concerns about environmental exposure and community interest in this device. Design and Sample: A cross‐sectional, internet‐based survey employing community‐based participatory research principles was utilized. 147 individuals participated from a focused Waycross, Georgia (58.5%) and broader national sample (41.5%). Measures: Variables included acceptable cost and number of testing samples, interest in conducting tests, levels of concern over pollutants, health status, housing, and demographics. Results: The majority of participants desired a system with fewer than 10 samples at ≤$15.00 per sample. Statistically significant higher levels of concern over air quality, formaldehyde exposure, and interest in testing formaldehyde were observed for those with overall worse health status and living in the Waycross, Georgia geographic region. Significant differences in formaldehyde testing interest were observed by health status (OR = 0.31, 95% CI = 0.12–0.81 for home testing) and geographic location (OR = 3.16, 95% CI = 1.22–8.14 for home and OR = 4.06, 95% CI = 1.48–11.12 for ambient testing) in multivariate models. Conclusions: Geographic location and poorer general health status were associated with concerns over and interest in formaldehyde testing. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: To determine the health literacy levels of persons living with human immunodeficiency virus (HIV) (PLWH) at a health clinic in the Dominican Republic (DR) and assess associations between health literacy, HIV‐related knowledge, and health information behavior (how patients need, seek, receive, and use information). Design and Sample: Cross‐sectional, descriptive. Participants were 107 PLWH attending the Clinic. Measures: A theoretically based, 64‐item survey assessing information behavior and HIV‐related knowledge was administered in Spanish through individual interviews. Health literacy was assessed using the Short Assessment of Health Literacy—Spanish and English. Results: On average, participants were 40.8 years old and had lived with HIV for 7.7 years. The majority (69.2%) had low health literacy. HIV‐related knowledge and information behavior varied by health literacy level and uncertainty regarding a main indicator of disease progression, viral load, was demonstrated regardless of health literacy level. Participants with low health literacy were less likely to answer questions or answer questions correctly and many participants (39.2%) indicated viral transmission can occur through supernatural means. Conclusions: Findings demonstrate unmet information need and that information received may not always be understood. Methods to improve health education are needed to ensure patients receive health information in an understandable way. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: Children of immigrants and refugees from developing countries are at risk for poor growth that could contribute to adult chronic disease. This study describes the physical growth, bone growth, body composition, metabolic risks, physical activity, and food security of Sudanese children living in the United States. Design and Sample: Cross‐sectional descriptive study of 64 Sudanese children age 5–18. Measures: Bone mineral content (BMC), bone density (aBMD), and body composition (fat, lean mass, percent body fat) were measured using DXA. Lipids, insulin, glucose, and hs‐CRP were analyzed using standardized laboratory methods. Food security was assessed with the U.S. Household Food Security Survey. Physical activity was measured through self‐report questionnaire and pedometers. Results: About 1/3 of children had low BMC and aBMD. Lean mass was low in 46%, and 32% were obese. Cholesterol, triglycerides, and HOMA‐IR were elevated in 23.4%, 32.8%, and 15.6% of children, respectively; only 22% of children were physically active and 40% experienced food insecurity. Conclusion: Sudanese children may have unique risks related to low bone mass low muscle mass, high percent body fat metabolic biomarkers, inactivity, and food insecurity potentially contributing to adult osteoporosis, diabetes, and cardiovascular disease. [ABSTRACT FROM AUTHOR]

Objective Guided by the Uses and Gratifications approach, to examine mothers' use and preference of e-Health media, and associated contextual factors. Design and Sample Cross-sectional survey of 165 mothers (White, African-American, and Hispanic) from a stratified random sample. Measures Use of online media about mother -baby care; favorite websites about motherhood and best-liked features of Web sites; channel preferences (Web site, postal mail, text) for receiving three types of health information; and contextual factors, e.g., education. Results Media use ranged from 96% for health information searches about babies to 46% for YouTube viewing about mother -baby topics. Contextual factors, such as education, were associated with media use. Babycenter was the most frequently reported favorite Web site and rich, relevant information was the best-liked feature. Across three health topics (weight, stress/depression, parenting) mothers preferred receiving information by Web site, followed by postal mail and least by text messaging (χ2 statistics, p < .001). Stress and race/ethnicity were among factors associated with preferences. Conclusions Mothers widely used e-Health related media, but use was associated with contextual factors. In public health efforts to reach new mothers, partnering with mother-favored Web sites, focusing on audience-relevant media, and adopting attributes of successful sites are recommended strategies. [ABSTRACT FROM AUTHOR]

Objectives This study aimed to identify factors influencing beliefs about intimate partner violence among Korean adults. Design and Sample This is a cross-sectional descriptive study that analyzed data from 466 adults. Measures Beliefs about intimate partner violence were measured using a self-report questionnaire with a total of 28 items consisting of four subscales: perpetrator's justification for beating women, blaming women for violence against them, perpetrator's responsibility for violence, and giving help to victims. Results Men and women had significantly different beliefs about intimate partner violence ( t = −7.19, p < .001). Some characteristics were identified that led to unhealthy beliefs about intimate partner violence. Four variables-gender, age, educational level, and witnessing parental violence-had an explanatory power of 20% with regard to beliefs about IPV ( F = 10.50, p = .000). Conclusions In South Korea, men, older individuals, and those with less formal education or who have witnessed parental violence need education to foster healthier beliefs about intimate partner violence. Nurses can play a vital role in efforts to decrease intimate partner violence. [ABSTRACT FROM AUTHOR]

Objective The study examined the relationship between exposure to e-cigarette advertising and e-cigarette use by pregnancy status, including use of flavored e-cigarette products, among women of childbearing age. Design A cross-sectional, correlational design was used. Subjects Female current or former tobacco users in Central and Eastern Kentucky, 18-45 years old ( N = 194, 52% pregnant). Measures Demographics, pregnancy status, cigarette and e-cigarette use, and exposure to e-cigarette advertising. Results Younger age, white non-Hispanic race, and greater exposure to e-cigarette advertising were associated with a higher likelihood of ever using e-cigarettes ( p < .05 for each variable). Pregnancy was not associated with ever use ( p = .11). Younger age was associated with use of flavored e-cigarettes ( p = .0027). Among e-cigarette users, those who used flavored products were more likely to have seen advertisements or information about e-cigarettes on social media, compared to those who used unflavored e-cigarettes only ( p = .016). Conclusion There is a link between advertising exposure and ever use of e-cigarettes. Pregnancy status is not significantly associated with ever use. Use of flavored e-cigarettes is associated with younger age. E-cigarette users with greater exposure to advertising on social media were more likely to use flavored products. [ABSTRACT FROM AUTHOR]

Objective The purpose of this systematic literature review was to assess the relationship between malnutrition and respiratory and diarrheal infections among children aged five and under living in Asian countries. Design and Sample The design was adapted from the PRISMA method to include case-control, cross-sectional, ecological, and experimental studies. A review of electronic databases identified 144 articles of which 20 met the inclusion criteria. The inclusion criteria were studies of malnourished children under the age of five with respiratory and/or diarrheal infections, admitted to hospitals or residing in villages throughout countries in Asia, and published between 2005 and 2015. Measures Infection was defined as the presence of a respiratory or diarrheal illness. Malnutrition was predominantly measured by WHO standards. Results Malnutrition is associated with respiratory and diarrheal infections. Children have higher rates of mortality when both malnourished and experiencing a respiratory infection. Conclusion Further research needs to examine the synergetic effect of diarrheal and respiratory infections in malnourished children and rates of mortality. Public health nurses ( PHNs) play a critical role in the prevention and treatment of malnutrition and infections in community and national systems. Obtaining better data will allow PHNs to provide critical care in the most underserved areas throughout Asia. [ABSTRACT FROM AUTHOR]

Objective Little nutrition research has been conducted among families with unstable housing. The objective of this study was to examine the role of food stamps (i.e., Supplemental Nutrition Assistance Program; SNAP) in home food availability and dietary intake among WIC families who experienced unstable housing. Design and Sample Cross-sectional study among vulnerable families. Low-income, multiethnic families with children participating in WIC ( n = 54). Measures Dietary intake was assessed with 24-hr recalls. Home food availability was assessed with an adapted home food inventory for low-income, multiethnic families. Validation results from adapted home food inventory for these families are also reported. Results SNAP households had more foods than non- SNAP households; few significant associations were observed between food availability and child dietary intake. Conclusions With few exceptions, the home food environment was not related to children's dietary intake among these vulnerable families. More research is needed on food access for families facing unstable housing. [ABSTRACT FROM AUTHOR]

Objectives: To explore public health nurses’ knowledge, perceptions, and practices under the Affordable Care Act (ACA). Design and Sample: A cross‐sectional, web‐based survey was completed by a sample of 1,143 public health nurses (PHNs) in the United States. Measures: Descriptive statistics were analyzed for variables related to general knowledge and perception of the ACA and for the extent of involvement in activities related to the implementation of the ACA. Qualitative analysis was conducted on free text comments to two open‐ended questions about current and future PHNs involvement in the ACA. Results: Approximately 45% of PHNs reported changes in their daily work due to the ACA. PHNs reported being very or somewhat involved in these activities of the ACA: integration of primary care and public health (62%), provision of clinical preventive services (60.3%), care coordination (55.4%), patient navigation (55.3%), establishment of private‐public partnerships (55.3%), population health strategies (53.6%), population health data assessment and analysis (53.8%), community health assessments (49%), involvement in medical homes (37.8%), provision of maternal and child health home visiting services (32.1%), and involvement in Accountable Care Organizations (29.2%). Conclusion: PHNs are making substantial contributions to implementation of the ACA. [ABSTRACT FROM AUTHOR]