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Whole school restorative practice (WSRP) calls for creating supportive, equitable schools, requiring broad systems change. This case study explores the journeys of three schools piloting WSRP in one Midwestern district and examines how school leaders designed and implemented within their school contexts. Schools were purposefully selected from within a three-year pilot project; data sources included annual interviews and focus groups with school leaders, and annual school reports. Each school developed a leadership team comprised of administrators and other staff who were knowledgeable of and committed to restorative justice principles. While grounded in common restorative principles, language, and approaches as part of their district's pilot project, school WSRP leaders simultaneously developed contextually-specific practices, including tailoring to learners' developmental stages. Overall, this study highlights the influential role of school leaders in navigating complexities that arise when working from a worldview that values human relationality and interconnection. Impact Statement: In this case study, school leaders' design and implementation of whole-school restorative practices (WSRP) reflected school-level contexts, including students' developmental stages, in alignment with restorative principles and values. Overall, this study highlights the influential role of school leaders in navigating whole-school change toward a worldview that values human relationality and interconnection. This study may inform how school psychologists, who often play a critical role in leading systems change initiatives in schools, can leverage their skills, knowledge, and experiences as part of WSRP leadership and implementation efforts.

Lesbian, gay, bisexual, and queer (LGBQ) youth experience more heterosexist bullying victimization than their straight peers, which contributes to mental health disparities. However, LGBQ youth may simultaneously experience other types of bias-based bullying (e.g., racist, cis-sexist, and able-ist bullying). Informed by intersectionality theory, this study describes intersections of LGBQ students' experiences of multiple forms of bias-based bullying and explores demographic correlates of individual types and typologies of bias-based bullying. This study uses 2016 state-wide survey data from 9th and 11th grade students in Minnesota schools. The analytic sample was limited to students who reported a LGBQ sexual orientation and responded to bullying items (N = 8313). Typology indicators were six items assessing bias-based bullying in the previous 30 days (race, gender, gender expression, sexual orientation, ability, weight). Covariates (age, sexual orientation, assigned sex, gender identity, race, perceived gender presentation, individualized education program (IEP), weight status) also predicted class membership. A latent class analysis (LCA) was conducted, and the three-class model was best fitting, with classes characterized by high levels of all types of bias-based bullying (6.3%), gender expression and sexual orientation bullying (35.2%), and low levels of bias-based bullying (58.4%). LGBQ youth who also identified as transgender or gender diverse, had an IEP, reported perceived nonconforming gender presentation, and youth of color were more likely to belong to the multiple bias-based bullying typology. Future work should leverage an intersectional lens to design multilevel interventions and strategies to prevent bias-based bullying that attend to broader issues of stigma within school systems.

Hispanic/Latina students face difficulties engaging in physical activity, but schools can help by integrating activity into accrue the school day and offering sport and activity-based extracurriculars. In this study, we examined physical activity (PA) and school-related factors among adolescent Hispanic/Latina students. Participants (N = 5,539) were eighth, ninth, and eleventh grade females identifying as Hispanic/Latina on the 2016 Minnesota Student Survey. We used descriptive statistics and a generalized linear model to examine relationships between school-related variables and days of [greater than or equal to] 60 minutes of PA in the past week. Many participants engaged in no physical education (44%), sports (61%), PA lessons (84%), or after-school activities (76%). More days of physical education, sport, and PA lessons associated with higher PA levels (p < 0.001), as did more days of non-sport activities (p [less than or equal to] 0.01) and feeling safer going to/from school (p [less than or equal to] 0.05). Significant interactions demonstrated the effect of physical education on PA was strongest for eighth grade students. Hispanic/Latina students' PA and engagement in school activities are limited, and schools' practices and policies should intentionally support these adolescents' PA early and throughout their educational careers.

This study examines the intersection of sexual and gender identities among adolescents, including the prevalence of these groups and rates of emotional distress and bullying victimization. Data come from a large population-based sample; two measures of sexual orientation and gender identity create eight identity groups. Youth who report identifying both as lesbian, gay, bisexual or queer/questioning (LGBQ) and as transgender/gender diverse (TGD) had significantly higher levels of two measures of emotional distress and four measures of bullying victimization than those who report only identifying as LGBQ non-TGD or straight TGD. Implications for research and practice are discussed.

Background: Peer harassment can have serious implications for students' success and well-being, and prevention programs need to consider the school context. This study aimed to: (1) identify groups of similar schools based on their risk and protective factors and demographic characteristics and (2) examine associations between school profiles and students' bullying involvement. Methods: Data came from 505 schools and 122,106 students who completed the 2013 Minnesota Student Survey. School-level risk and protective factors and demographic characteristics were included in a latent profile analysis (LPA) to identify profiles of schools. Multilevel logistic regression was used to assess associations between school profiles and peer harassment. Results: Six qualitatively different school profiles were identified. Unadjusted models showed that schools with higher levels of risk had greater odds of peer harassment. However, after controlling for student-level risk and protection, regardless of school-level risk, students in metro-area schools with a more diverse student body reported lower odds of bullying involvement. Conclusions: These findings highlight the importance of the social environment into peer harassment. In addition to addressing student-level risk and protection, larger community factors and norms also need to be taken into account for developing, selecting, and implementing the most effective approaches to bullying prevention.

Previous research, over a decade old, suggests students attending alternative high schools (AHS) engage in high levels of health-risk behaviors. Data from the 2007 Minnesota Student Survey for students attending AHS ("n" = 2,847) and traditional high schools (THS; "n" = 87,468) were used for this cross-sectional analysis to compare prevalence estimates, adjusted for age, race/ethnicity, and free and reduced lunch, for 28 health-risk behaviors. Students attending AHS were significantly more likely than students attending THS to report engaging in all behaviors related to unintentional injury and violence, tobacco use, alcohol and other drug use, and sexual activity, and were significantly less likely to report participating in physical activity, including sports teams. Students attending AHS continue to engage in high levels of health-risk behaviors as compared to their peers in THS. Updated national prevalence data were needed, as well as studies examining the role of protective factors in the lives of students attending AHS.

Women's studies and feminist curricula have been lauded for the development and application of critical thinking skills for social and political change in its students (Fisher; Kellner and Share; Mayberry). Critical thinking can be defined as the ability to identify and challenge assumptions, to search for alternative ways of thinking, and to summarize a reflective analysis (Ore). Yet for feminist pedagogues, the challenge of encouraging students to develop practical skills alongside knowledge of key concepts can be daunting. To address this issue, an existing course was redesigned to integrate critical thinking skills through media literacy activities. Inspired by "Second Thoughts: Critical Thinking for a Diverse Society" (Teays), the focus on increasing undergraduate students' media literacy was chosen because it was agreed that "being literate in the media age requires critical thinking skills that empower us as we make decisions" (NAMLE). In this article, the authors talk about Global Perspectives on Women and Change, a course that is part of Minnesota State University Mankato's Women's Studies core curriculum. They discuss how the course was redesigned by developing media literacy skills to advance critical thinking.

OBJECTIVES: Cisgender girls and boys report trading sex for something of value at roughly equal proportions; yet, boys are understudied and underserved. We compare boys who reported trading sex to those who never traded sex to address this gap in knowledge and practice. METHODS: The study is a secondary analysis of the Minnesota Student Survey, a triannual, census-style survey. The sample included 32 311 cisgender boy students in ninth and 11th grades who answered a question about sex trading. Bivariate descriptive statistics and multivariate logistic models were used to identify associated factors and determine the odds of trading sex on the basis of specific experiences. RESULTS: We found that 1.2% of boys reported trading sex. In bivariate analyses, boys who reported trading sex were more likely than those who did not to: identify as Black or Indigenous; report a marginalized gender identity or sexual expression; have had sexual intercourse; have experienced sexual harassment and harassment on the basis of sexual identity and race, ethnicity, and national origin; and to have experienced homelessness, food insecurity, foster care, and substance treatment (P < .001). In multivariate models, we found increased odds of trading sex for some variables, including a marginalized sexual identity, identifying as Black, and experiences of unstable housing, foster care, substance treatment, sexual harassment, and harassment based on gender (P < .001). CONCLUSIONS: These findings contribute new knowledge about boys who trade sex using a large, population-based sample and counter false assumptions and stereotypes. These data suggest new avenues of research, intervention, and prevention. [ABSTRACT FROM AUTHOR]

Purpose: Pediatric obesity disproportionately impacts Hispanic or Latino/a adolescents. Culturally appropriate family-based behavioral initiatives to improve weight status are warranted. The purpose of this research was to determine prevalence rates and identify protective factors associated with having overweight/obesity (body mass index ≥ 85th percentile) to inform Hispanic or Latino/a-targeted behavioral intervention development. Design: Secondary data analyses of a population-based statewide survey. Setting: Minnesota public high schools. Participants: Male (n = 2,644) and female (n = 2,798) Hispanic or Latino/a 9th and 11th graders (N = 5,442). Measures: Obesity-related behaviors (meeting fruit and vegetable [F&V] and physical activity [PA] recommendations), family caring, family country/region of origin, and weight status. Analysis: Stepwise logistic regression models (F&V, PA), stratified by biological sex, were used to identify protective factors of overweight/obesity. Results: The overall prevalence of meeting F&V and PA recommendations was 11.0% and 11.8%, respectively. Meeting F&V recommendations was not protective against overweight/obesity in either sex. Yet, males and females who met PA recommendations had significantly lower odds of having overweight/obesity (p <.05). In F&V and PA models, family caring was protective against overweight/obesity in females (p <.05), and family country/region of origin was protective against overweight/obesity in both sexes (p <.05). Conclusion: Findings illustrate a need for obesity prevention initiatives for Hispanic or Latino/a youth. More research is needed to understand the protective nature of family caring and country/region of origin. [ABSTRACT FROM AUTHOR]

Background: Dental utilization patterns and costs of providing comprehensive oral healthcare for older adults in different settings have not been examined. Methods: Retrospective longitudinal cohort data from Apple Tree Dental (ATD) were analyzed (N = 1,159 total; 503 outpatients, 656 long-term care residents) to describe oral health status at presentation, service utilization patterns, and care costs. Generalized estimating equation (GEE) repeated measures analysis identified significant contributors to service cost over the three-year study period. Results: Cohort mean age was 74 years (range = 55–104); the outpatient (OP) group was younger compared to the long-term care (LTC) group. Half (56%) had Medicaid, 22% had other insurance, and 22% self-paid. Most (72%) had functional dentitions (20+ teeth), 15% had impaired dentitions (9–19 teeth), 6% had severe tooth loss (1–8 teeth), and 7% were edentulous (OP = 2%, LTC = 11%). More in the OP group had functional dentition (83% vs. 63% LTC). The number of appointments declined from 5.0 in Year 1 (OP = 5.7, LTC = 4.4) to 3.3 in Year 3 (OP = 3.6, LTC = 3.0). The average cost to provide dental services was $1,375/year for three years (OP = $1,427, LTC = $1,336), and costs declined each year, from an average of $1,959 (OP = $2,068, LTC = $1,876) in Year 1 to $1,016 (OP = $989, LTC = $1,037) by Year 3. Those with functional dentition at presentation were significantly less costly than those with 1–19 teeth, while edentulous patients demonstrated the lowest cost and utilization. Year in treatment, insurance type, dentition type, and problem-focused first exam were significantly associated with year-over-year cost change in both OP and LTC patients. Conclusion: Costs for providing comprehensive dental care in OP and LTC settings were similar, modest, and declined over time. Dentate patients with functional dentition and edentulous patients were less costly to treat. LTC patients had lower utilization than OP patients. Care patterns shifted over time to increased preventive care and decreased restorative care visits. [ABSTRACT FROM AUTHOR]

Research has identified discrimination and a lack of knowledgeable providers as major barriers for transgender and gender diverse (TGD) individuals seeking care, which contributes to greater stress and significant health disparities affecting this population. However, research involving TGD youth is limited. The aim of this study, therefore, was to describe TGD adolescents' experiences, concerns and needs in healthcare settings, including their feedback on themes previously identified by healthcare providers (i.e. discomfort with gender‐related topics, reasons for not asking patients about gender and previous training regarding gender diversity). The authors conducted semi‐structured interviews with 12 TGD‐identified adolescents aged 14–17, living in Minnesota, USA in 2017–2018. Inductive thematic analysis was used to summarise participant comments into themes and subthemes. Two main themes were directly relevant to concerns and needs of TGD youth in healthcare settings and their views on healthcare providers' concerns: (a) asking about gender and pronouns and (b) training for healthcare providers. Findings suggest the need for revisions to clinic materials, infrastructure and protocols. Adding training to all general medical and nursing education to increase knowledge, comfort and competence around gender identity would further improve care and ultimately reduce healthcare disparities affecting TGD youth. [ABSTRACT FROM AUTHOR]

Background: We tested a model that incorporated potential developmental assets through which connections to parents and friends reduce the likelihood of engaging in non-suicidal self-injury (NSSI) among adolescents. Method: Data came from the 2016 Minnesota Student Survey, a population-based survey of 8th, 9th, and 11th grade students (N = 119,452). Chi-square test, t -test, and correlations evaluated bivariate relationships between all variables. Indirect effects of three developmental assets (social competency, positive identity, and empowerment) were modeled simultaneously on associations between connections to parents and friends, and past-year NSSI. Results: Bivariate analyses demonstrated protective effects of parent and friend connections on NSSI and that all developmental assets were negatively associated with NSSI. After accounting for demographic variables and associations between developmental assets in a multiple mediator path model, connections to parents showed a stronger, negative direct relationship with NSSI than did connections to friends. Developmental assets, especially positive identity and empowerment, accounted for a greater proportion of the effect of connections to friends on NSSI than the effect of connections to parents. Finally, social competency was no longer significantly related to NSSI in the multiple mediator path model. Conclusion: Clinical efforts to prevent NSSI should focus on enhancing adolescents' sense of positive identity and empowerment, as well as connections to parents and prosocial friends. [ABSTRACT FROM AUTHOR]

Retrospective studies using adult self-report data have demonstrated that adverse childhood experiences (ACEs) increase risk of violence perpetration and victimization. However, research examining the associations between adolescent reports of ACE and school violence involvement is sparse. The present study examines the relationship between adolescent reported ACE and multiple types of on-campus violence (bringing a weapon to campus, being threatened with a weapon, bullying, fighting, vandalism) for boys and girls as well as the risk of membership in victim, perpetrator, and victim–perpetrator groups. The analytic sample was comprised of ninth graders who participated in the 2013 Minnesota Student Survey (n ~ 37,000). Multinomial logistic regression models calculated the risk of membership for victim only, perpetrator only, and victim–perpetrator subgroups, relative to no violence involvement, for students with ACE as compared with those with no ACE. Separate logistic regression models assessed the association between cumulative ACE and school-based violence, adjusting for age, ethnicity, family structure, poverty status, internalizing symptoms, and school district size. Nearly 30% of students were exposed to at least one ACE. Students with ACE represent 19% of no violence, 38% of victim only, 40% of perpetrator only, and 63% of victim–perpetrator groups. There was a strong, graded relationship between ACE and the probability of school-based victimization: physical bullying for boys but not girls, being threatened with a weapon, and theft or property destruction (p s <.001) and perpetration: bullying and bringing a weapon to campus (p s <.001), with boys especially vulnerable to the negative effects of cumulative ACE. We recommend that schools systematically screen for ACE, particularly among younger adolescents involved in victimization and perpetration, and develop the infrastructure to increase access to trauma-informed intervention services. Future research priorities and implications are discussed. [ABSTRACT FROM AUTHOR]

Purpose: Understanding the root causes of the substantial disparities in risk and protective factors among transgender and gender diverse (TGD) adolescents is essential to the development and expansion of resources and supports for this vulnerable population. This study examines differences in emotional distress, bullying victimization, and protective factors among TGD high school students in city, suburban, town, and rural locations. Methods: Data come from a statewide school‐based survey conducted in Minnesota in 2016 (n = 2,168 TGD youth). Analysis of covariance models were used to predict the prevalence of multiple indicators of emotional distress, bullying victimization, and protective factors across the 4 location categories, with multiple adjustments. Findings: Significant linear trends were observed for 2 emotional distress outcomes and 2 bullying victimization outcomes, with urban TGD students having the lowest rates and rural having the highest prevalences. Additional significant differences in emotional distress were noted, with unexpectedly high rates of depressive symptoms and suicidal ideation among suburban students. Conclusions: Helping TGD adolescents in all types of locations identify resources and supportive professionals is critical to supporting this population. [ABSTRACT FROM AUTHOR]

BACKGROUND: Transgender and gender nonconforming (TGNC) adolescents have difficulty accessing and receiving health care compared with cisgender youth, yet research is limited by a reliance on small and nonrepresentative samples. This study's purpose was to examine mental and physical health characteristics and care utilization between youth who are TGNC and cisgender and across perceived gender expressions within the TGNC sample. METHODS: Data came from the 2016 Minnesota Student Survey, which consisted of 80 929 students in ninth and 11th grade (n = 2168 TGNC, 2.7%). Students self-reported gender identity, perceived gender expression, 4 health status measures, and 3 care utilization measures. Chi-squares and multiple analysis of covariance tests (controlling for demographic covariates) were used to compare groups. RESULTS: We found that students who are TGNC reported significantly poorer health, lower rates of preventive health checkups, and more nurse office visits than cisgender youth. For example, 62.1% of youth who are TGNC reported their general health as poor, fair, or good versus very good or excellent, compared with 33.1% of cisgender youth (χ² = 763.7, P < .001). Among the TGNC sample, those whose gender presentation was perceived as very congruent with their birth-assigned sex were less likely to report poorer health and longterm mental health problems compared with those with other gender presentations. CONCLUSIONS: Health care utilization differs between TGNC versus cisgender youth and across gender presentations within TGNC youth. With our results, we suggest that health care providers should screen for health risks and identify barriers to care for TGNC youth while promoting and bolstering wellness within this community. [ABSTRACT FROM AUTHOR]

Background Bullying and prejudice-based harassment frequently occur in school settings and have significant consequences for the health and wellbeing of young people. Yet far fewer studies have examined the role of the school environment in peer harassment than individual factors. This multilevel study examined associations between a variety of school-level risk and protective factors and student-level reports of bullying and prejudice-based harassment during adolescence. Methods Data come from 8th, 9th, and 11th graders who completed the 2013 Minnesota Student Survey ( N = 122,180 students nested in 505 schools). School-level variables were created by aggregating student report data in five areas: academic orientation to school, internal assets, teacher–student relationship quality, feelings of safety at school, and receipt of disciplinary action. Results Results indicated that youth attending schools with a higher proportion of students with strong internal assets had lower odds of nearly every type of bullying and prejudice-based harassment assessed when compared to youth attending schools with a lower proportion of students with strong internal assets. Additionally, the proportion of students feeling unsafe at school was a fairly consistent risk factor for most types of peer harassment. Conclusion Findings support the idea that prevention programs aimed at improving school-wide internal assets and feelings of safety at school may be key prevention points. [ABSTRACT FROM AUTHOR]

Objectives. We examined perpetration of bullying among youths in vulnerable groups relative to youths in peer groups not categorized as vulnerable. Methods. Data were collected in 2013 from a large school-based survey of adolescents conducted in Minnesota (n = 122 180). We used the v2 test and logistic regression to compare measures of perpetration of physical and relational bullying, as well as experiences of victimization and perpetration (or both), across categories of sexual orientation, weight status, and disability status. Results. Rates of physical and relational bullying perpetration were significantly higher among youths in vulnerable groups than among those not in vulnerable groups. With respect to context of victimization experiences, young men and women from vulnerable groups were overrepresented in the group comprising both perpetrators and victims. For example, odds of being both a perpetrator and a victim were 1.41 to 3.22 times higher among gay, lesbian, and bisexual youths than among heterosexual youths. Conclusions. Vulnerable youths, who are prone to peer harassment, may also act as perpetrators of bullying. Prevention strategies should address the particular needs of these populations; targeted programming may be appropriate. [ABSTRACT FROM AUTHOR]

This study examined relationships between social–emotional skills and involvement in bullying and violence among young adolescents from ethnically diverse, economically disadvantaged urban neighborhoods. Data were from 171 sixth- and seventh-grade students involved in a larger intervention study. Analyses examined relationships between social–emotional skills measures (intrapersonal skills, stress management skills, interpersonal skills) and involvement in violence, physical bullying, and relational aggression. Of social–emotional skills indicators, interpersonal skills and stress management skills demonstrated significant bivariate relationships with each of the bullying and violence outcomes. In multivariate models, greater interpersonal skills and greater stress management skills were significantly associated with lower odds of violence involvement. Greater stress management skills were also significantly associated with lower levels of physical bullying and relational aggression. Findings suggest that efforts to foster development of young adolescents’ social–emotional skills may, in turn, reduce their risk for involvement in bullying and violence. [ABSTRACT FROM PUBLISHER]

Abstract: To evaluate infant development using a modified Parent Evaluation of Development Status (PEDS) of 6 questions and the Meade Movement Checklist (MMCL). Parents of 4 to 6 month old infants attended community screening clinics, listed concerns on 6 questions (modified PEDS) and were then screened using the MMCL (n = 55). Individual PEDS questions were evaluated and MMCL results were compared to a gold standard, the Bayley Scales of Infant Development II. Significant correlation was found between infant risk-positive status, eligibility for special educational or medical services and parent concerns (RR = 1.7; P = .003). A second screen using the MMCL demonstrated 66.6% sensitivity, 94.1% specificity, 85.7% positive predictive value and 84.2% negative predictive value. Four of 6 questions on a “Modified” parent concerns test accurately targeted infants for a second screen (MMCL). Evaluating parent concerns and risk-positive status, increased PPV from 70% to 85.7% at the expense of decreased sensitivity. An algorithm is recommended to increase infant screening effectiveness. [Copyright &y& Elsevier]

Prior research has identified a relationship between youth hopelessness and violence perpetration within specific groups of young people. The purpose of this study was to evaluate the relationship between youth hopelessness and violence perpetration in a population-based sample of adolescents. This study is a cross-sectional analysis of data from 136,549 students in the 6th, 9th, and 12th grades responding to the 2007 Minnesota Student Survey. Logistic regression models were used to evaluate the relationship between hopelessness and youth violence perpetration, including comparison analyses for gender and race/ethnic subgroups as well as adjustment for a measure of poor-low affect. One in four youth (25.1%) reported levels of hopelessness at least enough to bother them in the previous month. Moderate-high levels of hopelessness exhibited a statistically significant independent relationship with a range of violence-related outcomes for youth subgroups: delinquent behavior, weapon carrying on school property, and all forms of self-directed violence. Relationships between hopelessness and interpersonal and intimate partner violence suggest a greater contribution by poor affective functioning for some groups. Interventions designed to reduce youth violence perpetration may benefit from increased strategies to address youth hopelessness as well as youth mental health in general. [ABSTRACT FROM AUTHOR]

This article discusses the initiation of a comparable worth wage policy in Minnesota. As of January 1986, Minnesota had progressed farther than any other state in implementing a comparable worth wage policy for public employees. This article is an analysis of Minnesota's pay equity policy so far, a report from the field midway through the initiation and implementation processes. The objectives are to provide the first detailed chronology recounting the initiation of this policy in Minnesota, and to analyze the Minnesota experience against the backdrop of national efforts to adopt and implement this policy.

Objective: Few studies have investigated associations between adverse childhood experiences (ACE) and nonmedical use of prescription medication (NMUPM) in population-based samples of adolescents, and even fewer have examined whether promotive factors might buffer these effects. The present study assesses the direct effects of ACE and positive student-teacher relationships on NUMPD and whether positive student-teacher relationships moderate this association.Design: Data were from the 2013 Minnesota Student Survey (MSS), an in-school survey administered every three years to students throughout Minnesota. The analytic sample (n=104,332) was comprised of 8th, 9th, and 11th graders.Results: Approximately 3% of students acknowledged past year NMUPM, the majority of whom reported at least one ACE. The most frequently used prescription drug was Ritalin/ADHD medications (1.71%) followed by opiate-based painkillers (1.67%), tranquilizers (0.92%), and stimulants (0.75%). Students who reported any use tended to use more than one medication. For every additional ACE, there was a 56%, 51%, 47%, and 52% increase in the odds of past year stimulant use, ADHD medication, pain reliever, and tranquilizer use, respectively. The estimated rate of the number of prescription drugs used increased by 62% for every additional ACE. Positive student- teacher relationships buffered the association between ACE and NMUPD, especially at higher levels of ACEs.Conclusion: Our findings have important implications for prevention work. Training educators to recognize trauma symptomology and cultivating strong student-teacher relationships are important considerations for future school-based substance use prevention initiatives. [ABSTRACT FROM AUTHOR]

Purpose: Youth smokers have high rates of adverse childhood experiences, and particularly parental incarceration (PI). In Minnesota, 16% of youth have experienced PI, but 55% of daily smokers report PI. However, no research has examined how PI relates to a range of tobacco products, which is critical considering the current e-cigarette epidemic. There is also limited research on protective factors for tobacco use among youth with PI.Methods: Data came from 2016 Minnesota Student Survey (N = 111,091); 85% of Minnesota schools participated. We assessed 30-day use of cigarettes, non-cigarette combustible products, smokeless products, e-cigarettes, and dual/poly use. Using descriptive statistics and logistic regressions, we compared use across current, previous, and no PI experience. We also tested how protective factors related to tobacco use.Results: Youth with current PI experience used all products with higher frequency compared to youth with previous and no PI experience. Use prevalence among youth with current PI were 26.0% (95% CI = 24.1, 27.8) for e-cigarettes, 20.8% (95% CI = 19.1, 22.5) for dual/poly use, 17.8% (95% CI = 16.2, 19.5) for cigarettes, 17.4% (95% CI = 15.8, 19.0) for combustible non-cigarettes, and 9.9% (95% CI = 8.6, 11.2) for smokeless products. Nearly all protective factors were significantly and negatively related to use of all products, regardless of PI experience.Conclusions: Youth with PI experience are at high risk for using multiple tobacco products. These disparities were most pronounced for e-cigarettes, demonstrating the e-cigarette epidemic is disproportionately occurring among youth with current and previous PI experience. All examined protective factors buffer risks for this population of youth. [ABSTRACT FROM AUTHOR]

Intimate partner sexual violence (IPSV) is a substantial public health issue faced by youth, with disparities along lines of race, gender, and sexual orientation. Using an intersectional framework, the current study describes the prevalence of self-reported IPSV victimization across intersecting social positions among adolescents. High school students who completed the 2019 Minnesota Student Survey were asked whether they had ever experienced IPSV. Using exhaustive Chi-Square Automatic Interaction Detection (eCHAID), responses were modeled using five indicators: racial/ethnic identity, transgender/genderqueer/genderfluid identity, sex assigned at birth, sexual orientation, and school location. The prevalence of IPSV victimization within each end group identified by the eCHAID varied from 2.6% to 32.0%. The highest prevalence of IPSV among all students was observed in subgroups defined by multiple marginalized social positions; for example, 32.0% among lesbian, gay, bisexual, queer, pansexual, or questioning (LGBQ+) students of color who were transgender, genderqueer, genderfluid or unsure of their gender, and assigned male at birth; 22.8% among LGBQ+ students assigned female at birth and enrolled in a Greater Minnesota (outside of the Twin Cities) school; and 22.2% among Native+ or missing race LGBQ+ students assigned female at birth and enrolled in a metropolitan school. Within the eCHAID decision tree, several subsamples of students were split into two more subsamples with a twofold or greater statistically significant difference in IPSV victimization prevalence between them. Findings from this study highlight notable disparities in the prevalence of IPSV victimization among Minnesota youth and demonstrate the importance of detailing the distribution of interpersonal violence outcomes across youth with multiple marginalized identities. Findings suggest that disparities reported along one categorical axis only may miss important nuances in how risk for IPSV is distributed. Population health researchers should utilize methods that allow for the explication of complex intersections that characterize individuals' social positions in estimating the prevalence of sexual violence., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interests with respect to the authorship and/or publication of this article.

Objectives. To describe the prevalence of sex trading by gender and by associations with mental health concerns and protective factors. Methods. We used data from 9th and 11th graders who completed the 2019 Minnesota Student Survey. The analytic sample (n = 67 806) included transgender and gender-diverse (TGD) youths and cisgender youths who reported trading sex. Data on 7 mental health measures and 4 school-related and health care-related protective factors were collected. Results. The prevalence of sex trading (5.9%) was 5 times higher among TGD students than cisgender students (1.2%). In addition, the prevalence of all mental health concerns was high among TGD students who traded sex (e.g., 75.9% reported a lifetime suicide attempt, as compared with 45.9% of cisgender students who traded sex). Fewer statistical differences were found across protective factors. When TGD students who traded sex were compared according to sex assigned at birth, no statistically significant differences were found. Conclusions. Our findings support strong calls for increased competence regarding gender and sex trading or exploitation in clinical and school-based settings to decrease health disparities among TGD youths. Public Health Implications. In this study, we have presented unique prevalence estimates of mental health disparities among TGD students in the United States who trade sex. Our results indicate that TGD students who trade sex are at risk for mental health symptoms and that sensitivity to both gender and sex trading or exploitation will be critical to meeting the needs of this group in clinical as well as school-based settings.

Purpose: Youth who trade sex for something of value experience enduring harm and risk of being trafficked. This study provides empirically-based prevalence estimates to guide policy and practice., Methods: This secondary analysis of 2019 population-level surveillance data from high school students in Minnesota (N = 71,007) uses descriptive statistics and chi-square tests to analyze self-reports of trading sex by demographics, relevant experiences, and health indicators., Results: The prevalence of trading sex among high school students in Minnesota was 1.4%. Cisgender boys and girls had similar rates; transgender students were much higher (5.9%). Rates varied significantly across race/ethnicity (e.g., Native youth, 3.1%), school location, and economic indicators. Students indicating other relevant experiences, such as having been treated for alcohol or drug use (15.1%), reported elevated rates of trading sex., Conclusions: Trading sex is a public health issue that affects high school students. The results show disparate rates of trading sex based on race/ethnicity and gender, with elevated rates among youth who engage in other risky behaviors and experienced other adverse experiences., (Copyright © 2020 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Context: Transgender and gender-diverse youth experience significant health disparities across numerous domains of health, including sexual health. Among general populations, parent connectedness has been strongly associated with youth sexual health., Methods: The relationships between parent connectedness and sexual health indicators were investigated among 2,168 transgender and gender-diverse youth who participated in the 2016 Minnesota Student Survey, a statewide population-based survey of ninth- and 11th-grade students. Multivariate logistic regression models, stratified by sex assigned at birth, tested associations between parent connectedness-youth's perceptions of parent caring and parent-youth communication-and eight sexual health indicators: ever having had sex, having multiple sexual partners in the past year, pregnancy involvement, substance use at last sex, partner communication about STI prevention, partner communication about pregnancy prevention, condom use at last sex and pregnancy prevention methods at last sex., Results: The level of parent connectedness was inversely associated with ever having had sex, regardless of sex assigned at birth (odds ratios, 0.6-0.8). Although level of connectedness was inversely associated with having multiple sexual partners in the past year and pregnancy involvement among transgender and gender-diverse youth assigned male at birth (0.6-0.7), these relationships were nonsignificant among transgender and gender-diverse youth assigned female at birth. Further differences in associations between parent connectedness and four sexual risk-reduction behaviors were found between youth assigned male at birth and those assigned female., Conclusions: As with other populations, parent connectedness promotes sexual health among transgender and gender-diverse youth and may provide a point of intervention., (Copyright © 2021 by the Guttmacher Institute.)

This study sought to identify factors distinguishing transgender/gender non-conforming (GNC) adolescents across three groups: no self-harm, non-suicidal self-injury (NSSI) only, and NSSI and suicide attempt (NSSI + SA). Data were from the 2016 Minnesota Student Survey. The final analytic sample included 1,635 transgender/GNC students in grades 9 and 11. Logistic regression analyses determined factors that best distinguished transgender/GNC students who reported self-harm (NSSI only or NSSI + SA) from those who reported no self-harm, and transgender/GNC adolescents who reported NSSI + SA from those who reported NSSI only. Final models were developed over 3 stages of analysis that tested associations of variables within risk factor, protective factor, and health-risk behavior domains to self-harm. Over half (51.6%) of transgender/GNC adolescents reported past-year self-harm behavior. Factors that consistently distinguished transgender/GNC youth who reported self-harm from those who reported no self-harm included reports of a mental health problem, depression, running away from home, and substance use (alcohol or marijuana use). Factors that distinguished the NSSI + SA group from the NSSI only group were reports of a mental health problem, physical or sexual abuse, relationship violence, bullying victimization, less parent connectedness, lower grades, lower levels of perceived school safety, and running away from home. Clinicians and school personnel need to be prepared to address risk factors and enhance protective factors that may reduce the likelihood this population of vulnerable youth will engage in NSSI and/or attempt suicide.

Introduction: Research has demonstrated a robust relationship between psychosocial risk factors (e.g., perceptions of health risk, peer and parent influences, and school climate) and adolescent tobacco use. However, whether internal assets (IAs), factors that promote healthy youth development, can mitigate the adverse effects of psychosocial risks on tobacco use has not been well researched., Method: Using a population-based sample of middle and high school students (N = 112,364), multilevel logistic and negative binomial regression models estimated the direct effects of cumulative psychosocial risks and IAs on student tobacco use (e.g., combustible, non-combustible, alternative delivery systems) and assessed whether IAs moderated the relationship between psychosocial risks and tobacco use., Results: Results indicate that every additional psychosocial risk factor was associated with an estimated 100% (AOR: 2.04, 95% CI: 1.88-2.22) to 57% (AOR: 1.57, 95% CI: 1.52-1.62) increase in the odds of using tobacco and a 60% increase in the estimated number of products used. IAs were inversely associated with tobacco use and attenuated the association between cumulative psychosocial risks and use. Among students experiencing all five psychosocial risks, boys had an estimated 20% reduction, and girls an estimated 50% reduction, in the probability of tobacco use at the highest mean scores of IAs., Conclusion: Universal, school-based prevention programs will benefit from identifying and targeting a set of shared risk and protective factors for tobacco use. Bolstering resilience by facilitating students' IAs represents a promising direction for youth focused prevention efforts., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Introduction: Important mental and physical health disparities exist for transgender and gender diverse youth compared with cisgender youth (i.e., those whose birth-assigned sex and gender identity align), yet little is known about factors that protect transgender and gender diverse youth from health problems. The objective of this paper is to identify modifiable protective factors in the lives of transgender and gender diverse adolescents, with the goal of informing efforts to eliminate disparities in depression, suicidality, and substance use in this population., Methods: Secondary data analysis of the 2016 Minnesota Student Survey examined associations between eight protective factors (connectedness to parents, adult relatives, friends, adults in the community, and teachers; youth development opportunities; and feeling safe in the community and at school) and depression, suicidality, and substance use (alcohol, binge drinking, marijuana, nicotine) among 2,168 adolescents who identified as transgender, genderqueer, genderfluid, or questioning their gender. Logistic regressions assessed the role of each protective factor separately and simultaneously., Results: Each protective factor was associated with lower odds of emotional distress and substance use. When protective factors were examined simultaneously, parent connectedness was protective for all measures. Feeling safe at school and connected to adults in one's community protected against depression and suicidality; teacher connectedness buffered risk of substance use., Conclusions: Given that transgender and gender diverse youth report lower levels of connectedness and safety, bolstering an explicitly transgender and gender diverse-friendly network of caring parents, safe and supportive schools, and connections to adults in the community may support efforts to eliminate disparities in depression, suicidality, and substance use., (Copyright © 2018 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.)

Purpose: As measures of birth-assigned sex, gender identity, and perceived gender presentation are increasingly included in large-scale research studies, data analysis approaches incorporating such measures are needed. Large samples capable of demonstrating variation within the transgender and gender diverse (TGD) community can inform intervention efforts to improve health equity. A population-based sample of TGD youth was used to examine associations between perceived gender presentation, bullying victimization, and emotional distress using two data analysis approaches., Methods: This secondary data analysis of the Minnesota Student Survey included 2168 9th and 11th graders who identified as "transgender, genderqueer, genderfluid, or unsure about their gender identity." Youth reported their biological sex, how others perceived their gender presentation, experiences of four forms of bullying victimization, and four measures of emotional distress. Logistic regression and multifactor analysis of variance (ANOVA) were used to compare and contrast two analysis approaches., Results: Logistic regressions indicated that TGD youth perceived as more gender incongruent had higher odds of bullying victimization and emotional distress relative to those perceived as very congruent with their biological sex. Multifactor ANOVAs demonstrated more variable patterns and allowed for comparisons of each perceived presentation group with all other groups, reflecting nuances that exist within TGD youth., Conclusion: Researchers should adopt data analysis strategies that allow for comparisons of all perceived gender presentation categories rather than assigning a reference group. Those working with TGD youth should be particularly attuned to youth perceived as gender incongruent as they may be more likely to experience bullying victimization and emotional distress.

Research demonstrates that young people involved in bullying are at greater risk for poor emotional health outcomes, but this association may not be consistent for youth of different sexual orientations. Understanding the unique needs of lesbian, gay, bisexual and questioning (LGBQ) youth may suggest important opportunities for intervention and prevention. This study, therefore, examines whether involvement with bullying is differentially associated with emotional well-being across sexual orientation. Survey data were collected from a large statewide sample of 9th and 11th grade students in 2013 (N = 79,039, 49.8% female, 74.6% white). Logistic regression tested associations between sexual orientation, physical or relational bullying perpetration and five measures of emotional health. In the full sample, those reporting bullying perpetration had significantly elevated odds of emotional health problems. However, interaction terms and stratified models indicated that in nine out of ten physical bullying models and two out of ten relational bullying models, perpetration was not as strongly associated with poor emotional health among LGBQ adolescents as it was among heterosexual youth. Possible explanations for this finding include unhealthy coping strategies or masking one's own vulnerable status as LGBQ. Continued efforts to prevent bullying are needed for all youth.

Purpose: To identify risk and protective factors associated with thinking about or attempting suicide among youth involved in verbal and social bullying., Methods: We analyzed data on 130,908 students in the sixth, ninth, and twelfth grades responding to the 2010 Minnesota Student Survey. Among students involved in frequent bullying (once a week or more during the past 30 days), we compared those who did and did not report suicidal ideation or a suicide attempt during the past year. Separate analyses were conducted for perpetrators only, victims only, and bully-victims., Results: Overall, 6.1% of students reported frequent perpetration only, 9.6% frequent victimization only, and 3.1% both. Suicidal thinking or a suicide attempt was reported by 22% of perpetrators only, 29% of victims only, and 38% of bully-victims. In logistic regression models controlling for demographic and other risk and protective factors, a history of self-injury and emotional distress were risk factors that cross-cut the three bullying involvement groups. Physical abuse, sexual abuse, a mental health problem, and running away from home were additional risk factors for perpetrators only and victims only. Parent connectedness was a cross-cutting protective factor, whereas stronger perceived caring by friends and by nonparental adults were additional protective factors for some groups., Conclusions: A range of risk and protective factors were associated with suicidal ideation and a suicide attempt among youth involved in verbal and social bullying. Findings may assist in identifying youth at increased risk for suicidal thinking and behavior and in promoting key protective factors., (Copyright © 2013 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

School-based depression screening and education programs are recommended for addressing the high rates of children's mental illness. The objectives of this study were to (1) identify Minnesota parent attitudes regarding the provision of school-based depression and suicide screening and education and (2) identify predictors of parent support for these school-based programs. A random sample of 1,300 Minnesota households with children ages 5-18 years was surveyed by mail. Chi-square tests and regression analyses were used to detect differences in parent support for depression and suicide screening and education across demographic categories, and parent beliefs and knowledge about depression and suicide. The response rate of eligible households was 43 % (N = 511). Overall, 84-89 % of parents supported school-based depression and suicide screening and education. After adjusting for all variables, parent support for depression screening was associated with greater knowledge [OR 8.48, CI(1.30-55.21)] and fewer stigmatizing beliefs [OR 0.03, CI(0.01-0.12)]. Support for suicide screening was associated with fewer stigmatizing beliefs [OR 0.03, CI(0.01-0.10)]. Support for depression education was associated with fewer stigmatizing beliefs [OR 0.32, CI(0.10-1.00)] and lower educational attainment [OR 0.59, CI(0.40-0.89)]. Support for suicide education was associated with greater knowledge [OR 7.99, CI(1.02-62.68)], fewer stigmatizing beliefs [OR 0.26, CI(0.07-0.92)], and lower educational attainment [OR 0.60, CI(0.38-0.94)]. Parent support for school-based depression and suicide screening and education was high. Parent education to decrease stigmatizing beliefs and increase knowledge about depression and suicide may increase support among the minority of parents who do not endorse such programs.

Purpose: This study investigates whether family and peer connections and prosocial norms buffer adolescent girls' violence involvement and whether a youth development intervention augments the power of these protective factors in reducing girls' risk for violence., Methods: Data were obtained from 253 13-17-year-olds enrolled in a randomized controlled trial of Prime Time, a youth development intervention offered through urban clinic settings to girls at high risk for pregnancy. Participants completed an audio computer-assisted self-interview survey at baseline and 6, 12, and 18 months after enrollment. Protective factors included scales assessing family and peer connections and prosocial norms. Outcome variables were violence victimization and perpetration scales measured at 18 months., Results: Family connections and prosocial norms independently protected girls against violence involvement. Peer prosocial norms also served as a protective buffer against violence perpetration and victimization; however, girls with strong peer connections had higher levels of violence perpetration. Participation in Prime Time augmented the protective effects of family and peer connections on girls' violence victimization but not perpetration. Prime Time participants who had high levels of family connections reported the lowest levels of violence victimization at 18 months. Prime Time participants with strong peer connections trended toward lower levels of violence victimization than other girls., Conclusions: Results suggest that effects of the Prime Time intervention on violence victimization were optimized among high-risk adolescent girls with strong connections to family and peers. The intervention was most potent in preventing violence victimization among girls with strong prosocial connections to family and peers., (Copyright © 2013 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: To identify factors distinguishing adolescents across 3 groups: no self-harm, nonsuicidal self-injury (NSSI) only, and NSSI and suicide attempt (NSSI + SA)., Methods: Data were from the 2007 Minnesota Student Survey. The sample included 61,330 students in grades 9 and 12. Logistic regression analysis determined factors that best distinguished adolescents who reported NSSI from those who reported no self-harm, and adolescents who reported NSSI + SA. Final models were developed over 3 stages of analysis that tested the importance of variables within risk factor, protective factor, and co-occurring health-risk behavior domains., Results: For male and female subjects, factors that consistently distinguished youth who reported NSSI from those who reported no self-harm included depressive symptoms, hopelessness, physical abuse, less parent connectedness, running away from home, and maladaptive dieting behavior. Factors that distinguished the NSSI + SA group from the NSSI only group for both sexes were a mental health problem, depressive symptoms, hopelessness, physical abuse, and running away from home. Other factors, such as sexual abuse, were significant in models for males or females only. Hopelessness constituted the leading factor to increase the likelihood that youth who self-injured also attempted suicide., Conclusions: Youth engaging in NSSI experience diverse psychosocial stressors and significant distress. Clinicians and school personnel are well-positioned to offer support to these youth. Furthermore, they can help address NSSI among youth by identifying those who self-injure early, assessing for hopelessness and suicidality, facilitating connections to prosocial adults, addressing maladaptive dieting behavior, and supporting runaway youth., (Copyright © 2012 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.)

We tested relationships between social connections, hope, and violence among young adolescents from socially distressed urban neighborhoods, and examined whether relationships between adolescents' family and school connectedness and violence involvement were mediated by hopefulness. Data were from middle school students involved in the Lead Peace demonstration study. The sample (N = 164) was 51.8% female; 42% African American, 28% Asian, 13% Hispanic, and 17% mixed race or other race; average age was 12.1 years; 46% reported physical fighting in the past year. In multivariate models, parent-family connectedness was protective against violence; school connectedness was marginally protective. Hopefulness was related to lower levels of violence. The relationship between school connectedness and violence was mediated by hopefulness; some evidence for mediation also existed in the family-parent connectedness and violence relationship. Findings warrant continued exploration of hopefulness as an important protective factor against violence involvement, and as a mediator in relationships between social connections and violence involvement.

This descriptive qualitative study compared how 18 teens (aged 14-16 years) with higher (n = 11; HiA(1c)) versus those with lower (n = 7; LoA(1c)) hemoglobin (Hb) A(1c) levels who met the standard of care viewed parental roles and involvement in diabetes management. Content analysis of the verbatim interview transcripts yielded five major themes. Teens in the LoA(1c) group (average HbA(1c) levels < or =8%) described their parents' monitoring roles more positively, whereas teens in the HiA(1c) group (average HbA(1c) levels >8%) were annoyed with reminders and described more conflict with their parents related to lack of adherence to their diabetes protocol. Clinicians need to assess the quality of parent-teen relationships and provide developmentally appropriate interventions to help teens and their parents effectively negotiate role transitions related to diabetes management during middle adolescence.

American Indian elders have long been the grandparents to not only their own relatives but also other 'grandchildren' in their tribes, clans and extended families. This worldview demands an elder-youth connection and has been integral to the success of the "American Indian MS to PhD Nursing Science Bridge" at the University of Minnesota, School of Nursing. Elders support the program mission to increase the number (from 12) of doctorally prepared Native nurses. They have been participants in formal and informal programming, special advising, and presence from reservations and in urban Minneapolis. Program feedback reveals cultural value in the elders' presence.

Viral contamination of public waters is a leading health concern around the world, including in Minnesota where cold climate, abundant onsite systems on poor or thin soils, and abundant surface water resources present a significant risk of wastewater pathogens reaching sensitive water sources. Three alternative onsite treatment systems, a sand filter, peat filter and subsurface-flow constructed wetland (CW) at a field research site were evaluated for seasonal virus removal by seeding each with MS2 bacteriophage. The sand and peat filters and CW removed 2.7, 7.0, and 1.4 log10 of MS2, respectively, during summer and 1.8 and 6.9 log for the sand and peat filter during winter (CW not seeded). Somatic coliphage reductions for the sand filter, peat filter and CW were 2.9, 3.5, 1.0 log10 in summer, and 1.5, 2.8, 0.7 log10 during winter, respectively over a 3 year period. During this period, fecal coliform log10 reductions were 2.9, 4.6, 2.0 in summer for the sand and peat filters and CW, and 2.0, 4.6, 1.6 in winter. The peat filter was the most effective system for removing MS2, somatic coliphage and fecal coliforms during both winter and summer but all systems removed > 90% of viruses throughout the year.

Objective: To describe physician practices, ranging from solo and two-physician practices to large medical groups, in three geographically diverse parts of the country with strong managed care presences., Data Sources/study Design: Surveys of medical practices in three managed care markets conducted in 2000-2001., Study Design: We administered questionnaires to all medical practices affiliated with two large health plans in Boston, MA, and Portland, OR, and to all practices providing primary care for cardiovascular disease patients admitted to five large hospitals in Minneapolis, MN. We offer data on how physician practices are structured under managed care in these geographically diverse regions of the country with a focus on the structural characteristics, financial arrangements, and care management strategies adopted by practices., Data Collection: A two-staged survey consisting of an initial telephone survey that was undertaken using CATI (computerized assisted telephone interviewing) techniques followed by written modules triggered by specific responses to the telephone survey., Principal Findings: We interviewed 468 practices encompassing 668 distinct sites of care (overall response rate 72 percent). Practices had an average of 13.9 member physicians (range: 1-125). Most (80.1 percent) medium- (four to nine physicians) and large-size (10 or more physicians) groups regularly scheduled meetings to discuss resource utilization and referrals. Almost 90 percent of the practices reported that these meetings occurred at least once per month. The predominant method for paying practices was via fee-for-service payments. Most other payments were in the form of capitation. Overall, 75 percent of physician practices compensated physicians based on productivity, but there was substantial variation related to practice size. Nonetheless, of the practices that did not use straight productivity methods (45 percent of medium-sized practices and 54 percent of large practices), most used arrangements consisting of combinations of salary and productivity formulas., Conclusions: We found diversity in the characteristics and capabilities of medical practices in these three markets with high managed care involvement. Financial practices of most practices are geared towards rewarding productivity, and care management practices and capabilities such as electronic medical records remain underdeveloped.

The purpose of this study was to estimate and compare preference scores derived from MOS Short Form-36 (SF-36) data for a sample of lung transplant patients using three methodologies: Fryback et al. (Med Decis Making 1997; 17: 1-9), Nichol et al. (Med Decis Making 2001; 21: 105-112) and Brazier et al. (J Health Econ 2002: 21: 271-292). Data were gathered from 99 lung transplant recipients using a mail survey, which included the SF-36 and other health-related quality of life (HRQL) measures. The mean preference score for the sample was 0.643 (range 0.43-0.83), 0.765 (range 0.36-1.0), and 0.697 (range 0.33-1.00) for Fryback, Nichol and Brazier methods, respectively. Correlations between the derived scores and visual analogue ratings of health (0.58-0.68) and pulmonary symptoms (-0.59 to -0.62) were moderate to good and in the expected directions. The mean preferences of patients grouped by levels of dyspnea, depression symptoms, illness burden, and self-rated general health differed significantly with all methods and supported the construct validity of the derived scores as measures of preference. The Nichol and Brazier scores, both derived with standard gamble utilities, were generally higher than Fryback scores, which are not utility-based. Given the popularity of the SF-36, these three methods could be useful where direct elicitation of preferences is not feasible. Researchers must be cognizant of the derivation method used, as absolute preference levels, hence quality adjusted life years (QALYs), will differ by method.

The purpose of this study was to describe the knowledge and attitudes of nursing faculty and students (BSN and MS) regarding complementary/alternative therapies (C/AT) and their integration into nursing practice. Implications for curricular and faculty development were also identified. A cross-sectional survey (n = 170) of graduating BSN students (n = 73) and MS and PhD students (n = 47) and faculty (n = 50) was conducted in a university-based nursing program. The self-administered questionnaire contained 134 forced choice items. Questions assessed attitudes and knowledge about training in, personal use of, perceived barriers to, and intent to integrate C/AT into clinical practice. Over 95 percent of the students and faculty agreed that clinical care should integrate the best of conventional and C/AT practices. Few had received formal C/AT education; the highest number had received some education about massage, music, prayer/spiritual healing, and therapeutic/healing touch. They desired more education but not necessarily the skills to perform these therapies themselves. Faculty and students expressed positive attitudes about incorporating C/AT into curricula and nursing practice. Current knowledge lags behind interest, however, suggesting a situation ripe for change. The most important perceived barrier to incorporation was lack of evidence. Curricular change is needed to fully integrate C/AT in nursing programs at all levels; faculty development and nursing research is needed to facilitate these changes.