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Suicide is the 10th leading cause of death in the United States and is a major concern among professional American firefighters, with rates for suicidal ideation in firefighters two times higher than rates in the general population. The Neuman systems model integrated with the interpersonal-psychological theory of suicide provides a better understanding of the specific occupational and cultural aspects of firefighting that lead to a greater risk for suicidal ideation. This model provides an innovative lens that can inform the development and the implementation of interventions aimed at preventing suicidal ideation among firefighters.

Sexually assaulted patients who seek care in emergency departments are often recommended for nonoccupational HIV postexposure prophylaxis treatment. HIV postexposure prophylaxis is an effective method in preventing HIV transmission if the treatment is administered promptly and if a full 28-day course is completed. However, research has shown that only a fraction of patients who start the treatment will complete a 28-day course. Research is needed to explore factors that may be associated with compliance to postexposure prophylaxis so that interventions can be designed to address the factors that put patients at risk for noncompletion.A retrospective chart review was conducted examining 246 medical records of sexually assaulted female patients who presented to one of two urban hospitals. A number of patient and event-related factors were examined to determine whether they were associated with HIV postexposure prophylaxis adherence among patients presenting at an emergency room after a sexual assault.Results revealed that five factors showed significant associations with sexually assaulted female patients completing HIV postexposure prophylaxis treatment. These factors include educational level, employment, health insurance, vaginal injuries, and tongue-mouth assaults.The results of this study represent a starting point from which to inform the development of targeted interventions such that those most at risk for nonadherence can receive additional support or services to improve HIV postexposure prophylaxis adherence.

Asthma is among the most common chronic diseases of children in the United States (US). Mold exposures have been linked to asthma development and exacerbation. In homes, mold exposures have been quantified using the Environmental Relative Moldiness Index (ERMI), and higher home ERMI values have been linked to occupant asthma.In this analysis of the School Inner-City Asthma Study (SICAS), we aimed to evaluate the ERMI's applicability to measuring mold in schools compared with homes and to examine the prevalence of asthma in relationship to students' demographics and the physical characteristics of school buildings.Northeastern US schools (n = 32) and homes (n = 33) were selected, and the 36 ERMI molds were quantified in a dust sample from each classroom (n = 114) or home. School building characteristics data were collected from SICAS. Asthma prevalence and student demographics data were obtained from government websites. Linear regression and mixed models were fit to assess the association of the current asthma prevalence and physical characteristics of the school, make-up of the student body, and the ERMI metric.Levels of outdoor group 2 molds were significantly (P.01) greater in schools compared with homes. The presence of air-conditioning in school buildings correlated significantly (P = .02) with lower asthma prevalence.The prevalence of asthma in student bodies is associated with many factors in schools and homes.

To identify significant patient and system access barriers and facilitators to dermatology care in one rural health system with limited dermatology appointment availability.Mixed methods study using data from electronic medical records, patient surveys, stakeholder semi-structured interviews, and service area dermatologist demographics. Retrospective data were collected between 1 January 2017-1 March 2018, and interviews and surveys were conducted between June 1-August 31, 2018. Participants were recruited from two primary care practices in one rural Maine regional health system.Findings from thematic analyses, descriptive statistics, and statistical modelling were integrated using Chi-square tests for homogeneity to develop a unified understanding. Statistical modelling using odd-ratio logistic and linear regression were performed for each outcome variable of interest.Urgent referrals by primary care increased the likelihood of dermatology care overall (OR: 6.771; p = .007) and at nearby sites with limited availability (OR: 4.024; p = .024), but not at geographically further sites with higher capacities (p = .844). Referral under-diagnosis occurred in 20.8% of those biopsied. Older (p = .041) or non-working (p = .021) patients were more likely to remain unevaluated than seek more available but geographically further care.In rural areas with scarce appointment availability, primary care provider diagnostic accuracy may be an important barrier of dermatology care receipt and health outcomes, especially among at-risk populations.Although melanoma mortality rates are decreasing throughout the US, little is known about why rates in Maine continue to rise. This study applied a comprehensive approach to identify several patient and system access barriers to dermatology care in one underserved rural regional health system. While specific to this population and large service area, these findings will inform improvement efforts here and support broader future research efforts aimed at understanding and improving health outcomes in this rural state.目标: 在一个难以预约到皮肤科的农村卫生体系中,确定患者和系统获得皮肤科护理的重要障碍因素和促进因素。 设计: 混合方法研究使用来自电子病历、患者调查、利益相关者半结构化采访和服务地区皮肤科医生人口统计的数据。在2017年1月1日至2018年3月1日期间收集回顾性数据,并在2018年6月1日至8月31日期间进行采访和调查。参与者来自缅因州一个农村地区卫生体系的两个基层医疗机构。 方法: 主题分析、描述性统计和统计建模的结果通过卡方检验进行整合,以形成统一的理解。对每个感兴趣的结果变量采用比值比逻辑回归和线性回归进行统计建模。 结果: 基层医疗机构的紧急转诊增加了获得整体皮肤科治疗(比值比:6.771;p = 0.007)以及获得有限皮肤科治疗的附近地点(比值比:4.024;p = 0.024)可能性,但在地理位置较远、体量更大的地点(p = 0.844)这一可能性并未增长。在这些进行活检患者中,20.8%转诊未能作出全面性诊断。老年 (p = 0.041) 或非工作(p = 0.021)患者的未评估率比位置偏远但需要做进一步治疗的患者的未评估率更高。 结论: 在缺乏预约的农村地区,初级保健提供者的诊断准确性可能是皮肤科护理接受和健康结果的重要障碍,尤其是在高危人群中。 影响: 尽管黑素瘤的死亡率在美国各地都在下降,但人们对缅因州黑素瘤死亡率继续上升的原因知之甚少。本研究采用一种综合方法,在一个服务不到位的农村地区卫生体系中,确定了几个患者难以获取皮肤科就医体系的障碍。虽然这些研究结果是针对这一人口和大型服务区的,但它们将为这里提供改进工作信息,并为今后旨在了解和改善这个农村州健康状况的更广泛的研究工作提供支持。.

Little is known about the construct of patient activation for engaging in favorable self-management behaviors in people with HIV. We conducted a cross-sectional study among young Black women with HIV (n = 84) to examine the association between stigma and patient activation and the mediating role of social support and resilience. Social support mediated the relationship between the following dimensions of stigma and patient activation: internalized (β = -0.20, SE = 0.08, CI [-0.369 to -0.071]) and anticipated in health care settings (β = -0.06, SE = 0.04, CI [-0.177 to -0.001]). Resilience mediated the relationship between the following dimensions of stigma and patient activation: anticipated in health care (β = -0.20, SE = 0.08, CI [-0.387 to -0.057]) and community settings (β = -0.15, SE = 0.08, CI [-0.318 to -0.017]), and enacted in community settings (β = -0.14, SE = 0.09, CI [-0.332 to -0.001]). Our findings suggest intrapersonal and interpersonal mechanisms by which various dimensions of stigma contribute to patient activation, thus identifying social support, resilience, and patient activation as potential intervention targets.

Health communication is a key health promotion approach for translating research findings into actionable information. The purpose of this study was to use participatory design to create and then test the usability and comprehension of an HIV self-testing infographic in a sample of 322 emerging adult, sexual minority men of color. Our study objectives addressed three challenges to HIV self-testing: (1) correct usage of the test stick, (2) understanding the number of minutes to wait before reading the result, and (3) how to correctly interpret a negative or a positive HIV result. This study was a two-phase, sequential, mixed methods, pilot, online, randomized controlled trial. Results suggested a significant mean difference between the control and intervention groups on HIV self-testing knowledge, with the control group outperforming the intervention group. However, two-thirds or better of the participants in the intervention group were able to comprehend the three critical steps to HIV self-testing. This was a promising finding that has resulted in the authors’ development of additional recommendations for using participatory design for visual aid development in HIV prevention research. Participatory design of an HIV self-testing infographic is a rigorous approach, as a health communication strategy, to address public health priorities.

Background Precision health considers individual lifestyle, genetics, behaviors, and environment context and facilitates interventions aimed at helping individuals achieve well-being and optimal health. Purpose To present the Nursing Science Precision Health (NSPH) Model and describe the integration of precision health concepts within the domains of symptom and self-management science as reflected in the National Institute of Nursing Research P30 Centers of Excellence and P20 Exploratory Centers. Methods Center members developed the NSPH Model and the manuscript based on presentations and discussions at the annual NINR Center Directors Meeting and in follow-up telephone meetings. Discussion The NSPH Model comprises four precision components (measurement; characterization of phenotype including lifestyle and environment; characterization of genotype and other biomarkers; and intervention target discovery, design, and delivery) that are underpinned by an information and data science infrastructure. Conclusion Nurse scientist leadership is necessary to realize the vision of precision health as reflected in the NSPH Model.

Precision health considers individual lifestyle, genetics, behaviors, and environment context and facilitates interventions aimed at helping individuals achieve well-being and optimal health. The purposes of this manuscript are to present the Nursing Science Precision Health (NSPH) Model and describe the integration of precision health concepts within the domains of symptom and self-management science as reflected in the National Institute of Nursing Research P30 Centers of Excellence and P20 Exploratory Centers. Center members developed the NSPH Model and the manuscript based on presentations and discussions at the annual NINR Center Directors Meeting and in follow-up telephone meetings. The NSPH Model comprises four precision components (measurement; characterization of phenotype including lifestyle and environment; characterization of genotype and other biomarkers; and intervention target discovery, design, and delivery) that are underpinned by an information and data science infrastructure. Nurse scientist leadership is necessary to realize the vision of precision health.

Purpose of Review Asthma is a chronic respiratory condition with increasing domestic and worldwide prevalence that burdens individuals and the healthcare system with high costs associated with long-term treatments and acute emergency room (ER) visits. It can be triggered by ambient microbes, including bacteria, viruses, and fungi. In this review, we examine the outcomes of asthma patients in relation to environmental exposures to ambient microbe products, focusing on whether exposure leads to asthma development from birth to childhood and if particular microbes are associated with worsened asthma exacerbations. Recent Findings Bacterial endotoxin is more prominent in homes with pets and may cause cytokine cascades that lead to asthma exacerbation. However, some studies have demonstrated a protective effect with early exposure. Patients with positive Aspergillus skin testing are more prone to moderate-severe or severe-uncontrolled asthma. Fungal sensitization is also associated with earlier onset of asthma and demonstrates a dose-dependent relationship of symptom severity and duration. Among viruses, rhinovirus has the greatest association with decreased lung function, severe asthma, and asthma-related hospital admissions. Distribution of microbial products and associated asthma symptoms depends on the geographical climate. Genetic variations among individuals also mitigate the effects of microbial products on asthma development and symptom severity. Summary Microbial products of bacteria, fungi, and viruses are associated with the development of asthma, more severe asthma symptoms, and worse outcomes. However, some early exposure studies have also demonstrated a protective effect. Bacterial and fungal products are related to decreased lung function and earlier onset of asthma. Viral products are related to asthma-associated hospital admissions; and the climate and patient genetics can also temper or intensify the relationships between microbial products, asthma development, and asthma symptom severity. Further research should focus on the effects of early microbe exposure and its interaction with human immune systems and asthma-related outcomes.

New HIV infection rates in Black women are 15 times higher than that of White women, and new infections in women have been primarily associated with heterosexual sex. Encouraging sex partner testing may increase HIV status awareness. Prevention campaigns have not recommended specific approaches with established efficacy for women to encourage partner testing. We examined approaches to encourage HIV testing, interpersonal contexts of relationships, and HIV testing behaviors in 18- to 29-year-old Black women (n = 158). Findings from our quantitative analysis included the following: (a) Partner type (main or nonmain), intimate risk taking, sexual coercion, condom use, and age were related to varied approaches (Active Persuasion, Decisive Collaboration, Ultimatum, and Sweet Talking); (b) the greatest predictor of male partner HIV testing was whether the female partner had been tested for HIV; and (c) Active Persuasion and Decisive Collaboration approaches were associated with partner HIV testing. These findings can inform HIV prevention campaigns.

The purpose of this systematic review was to assess the state of adherence to HIV care such as HIV medication and appointment adherence among Black women in the United States. After a systematic search of CINAHL, PubMed, EMBASE, and clinicialtrials.gov, 26 studies and two ongoing trials met inclusion criteria. Psychosocial factors such as intersectional stigmas and depression were among the salient factors associated with adherence-to-care behaviors in women living with HIV (WLWH). In addition, interpersonal factors such as social support and the patient-provider relationship were frequently associated with adherence-to-care behaviors. No culturally relevant interventions for Black WLWH were found in the literature, but one ongoing trial that was developed specifically for Black WLWH seemed promising. Considering the dearth of tailored interventions, more gender-specific and culturally relevant interventions are urgently needed to improve adherence-to-care behaviors and optimize health outcomes for Black WLWH.

Background and Purpose:Black women are disproportionately affected by HIV. Increasing status awareness through partner testing can improve status awareness and reduce transmission. Varying approaches to encourage HIV testing are described but a measurement instrument is lacking. The AIDS Discussion Strategy Scale (ADSS) was adapted into the HIV Testing Approach Scale (HTAS) to measure Black women's approaches to encourage partners to test for HIV.Methods:Preliminary adaptation included five steps to ensure validity. Participants comprised 158 sexually active 18–29-year-old Black women. The HTAS was analyzed with principal components analysis (PCA).Results:PCA indicated a four-factor model explaining 67% of variance. Four distinct approaches were Active Persuasion, Decisive Collaboration, Ultimatum, and Sweet Talking. The HTAS approaches demonstrated adequate reliability.Conclusion:The HTAS may serve as a valid and reliable instrument for research. HIV prevention should encourage testing discussion to increase status awareness.

PURPOSE Biomarkers as common data elements (CDEs) are important for the characterization of biobehavioral symptoms given that once a biologic moderator or mediator is identified, biologically based strategies can be investigated for treatment efforts. Just as a symptom inventory reflects a symptom experience, a biomarker is an indicator of the symptom, though not the symptom per se. The purposes of this position paper are to (a) identify a "minimum set" of biomarkers for consideration as CDEs in symptom and self-management science, specifically biochemical biomarkers; (b) evaluate the benefits and limitations of such a limited array of biomarkers with implications for symptom science; (c) propose a strategy for the collection of the endorsed minimum set of biologic samples to be employed as CDEs for symptom science; and (d) conceptualize this minimum set of biomarkers consistent with National Institute of Nursing Research (NINR) symptoms of fatigue, depression, cognition, pain, and sleep disturbance. DESIGN AND METHODS From May 2016 through January 2017, a working group consisting of a subset of the Directors of the NINR Centers of Excellence funded by P20 or P30 mechanisms and NINR staff met bimonthly via telephone to develop this position paper suggesting the addition of biomarkers as CDEs. The full group of Directors reviewed drafts, provided critiques and suggestions, recommended the minimum set of biomarkers, and approved the completed document. Best practices for selecting, identifying, and using biological CDEs as well as challenges to the use of biological CDEs for symptom and self-management science are described. Current platforms for sample outcome sharing are presented. Finally, biological CDEs for symptom and self-management science are proposed along with implications for future research and use of CDEs in these areas. FINDINGS The recommended minimum set of biomarker CDEs include pro- and anti-inflammatory cytokines, a hypothalamic-pituitary-adrenal axis marker, cortisol, the neuropeptide brain-derived neurotrophic factor, and DNA polymorphisms. CONCLUSIONS It is anticipated that this minimum set of biomarker CDEs will be refined as knowledge regarding biologic mechanisms underlying symptom and self-management science further develop. The incorporation of biological CDEs may provide insights into mechanisms of symptoms, effectiveness of proposed interventions, and applicability of chosen theoretical frameworks. Similarly, as for the previously suggested NINR CDEs for behavioral symptoms and self-management of chronic conditions, biological CDEs offer the potential for collaborative efforts that will strengthen symptom and self-management science. CLINICAL RELEVANCE The use of biomarker CDEs in biobehavioral symptoms research will facilitate the reproducibility and generalizability of research findings and benefit symptom and self-management science.

Background The Center for Technology in Support of Self-Management and Health (NUCare) is an exploratory research center funded by the National Institute of Nursing Research's P20 mechanism positioned to conduct rigorous research on the integration of technology in the self-management of the older adult population. Purpose The purpose of this paper is to describe the development and application of an evaluation plan and preliminary evaluation results from the first year of implementation. Methods This evaluation plan is derived from and is consistent with Dorsey et al.'s (2014) logic model. Dorsey's model provided guidelines for evaluating sustainability, leveraging of resources, and interdisciplinary collaboration within the center. Discussion Preliminary results and strategies for addressing findings from the first year of evaluation are discussed. A secondary aim of this paper is to showcase the relevance of this center to the advancement and maintenance of health in the aging population.

Neighborhood-level structural interventions are needed to address HIV/AIDS in highly affected areas. To develop these interventions, we need a better understanding of contextual factors that drive the pandemic. We used multinomial logistic regression models to examine the relationship between census tract of current residence and mode of HIV transmission among HIV-positive cases. Compared to the predominantly white high HIV prevalence tract, both the predominantly black high and low HIV prevalence tracts had greater odds of transmission via injection drug use and heterosexual contact than male-to-male sexual contact. After adjusting for current age, gender, race/ethnicity, insurance status, and most recently recorded CD4 count, there was no statistically significant difference in mode of HIV transmission by census tract. However, heterosexual transmission and injection drug use remain key concerns for underserved populations. Blacks were seven times more likely than whites to have heterosexual versus male-to-male sexual contact. Those who had Medicaid or were uninsured (versus private insurance) were 23 and 14 times more likely, respectively, to have injection drug use than male-to-male sexual contact and 10 times more likely to have heterosexual contact than male-to-male sexual contact. These findings can inform larger studies for the development of neighborhood-level structural interventions.

Purpose This article outlines how current nursing research can utilize technology to advance symptom and self-management science for precision health and provides a roadmap for the development and use of technologies designed for this purpose. Approach At the 2018 annual conference of the National Institute of Nursing Research (NINR) Research Centers, nursing and interdisciplinary scientists discussed the use of technology to support precision health in nursing research projects and programs of study. Key themes derived from the presentations and discussion were summarized to create a proposed roadmap for advancement of technologies to support health and well-being. Conclusions Technology to support precision health must be centered on the user and designed to be desirable, feasible, and viable. The proposed roadmap is composed of five iterative steps for the development, testing, and implementation of technology-based/enhanced self-management interventions. These steps are (a) contextual inquiry, focused on the relationships among humans, and the tools and equipment used in day-to-day life; (b) value specification, translating end-user values into end-user requirements; (c) design, verifying that the technology/device can be created and developing the prototype(s); (d) operationalization, testing the intervention in a real-world setting; and (e) summative evaluation, collecting and analyzing viability metrics, including process data, to evaluate whether the technology and the intervention have the desired effect. Clinical relevance Interventions using technology are increasingly popular in precision health. Use of a standard multistep process for the development and testing of technology is essential.

Background Access to healthcare is a poorly defined construct, with insufficient understanding of differences in facilitators and barriers between US urban versus rural specialty care. We summarize recent literature and expand upon a prior conceptual access framework, adapted here specifically to urban and rural specialty care. Methods A systematic review was conducted of literature within the CINAHL, Medline, PubMed, PsycInfo, and ProQuest Social Sciences databases published between January 2013 and August 2018. Search terms targeted peer-reviewed academic publications pertinent to access to US urban or rural specialty healthcare. Exclusion criteria produced 67 articles. Findings were organized into an existing ten-dimension care access conceptual framework where possible, with additional topics grouped thematically into supplemental dimensions. Results Despite geographic and demographic differences, many access facilitators and barriers were common to both populations; only three dimensions did not contain literature addressing both urban and rural populations. The most commonly represented dimensions were availability and accommodation, appropriateness, and ability to perceive. Four new identified dimensions were: government and insurance policy, health organization and operations influence, stigma, and primary care and specialist influence. Conclusions While findings generally align with a preexisting framework, they also suggest several additional themes important to urban versus rural specialty care access.

Purpose Common data elements (CDEs) are increasingly being used by researchers to promote data sharing across studies. The purposes of this article are to (a) describe the theoretical, conceptual, and definition issues in the development of a set of CDEs for research addressing self-management of chronic conditions; (b) propose an initial set of CDEs and their measures to advance the science of self-management; and (c) recommend implications for future research and dissemination. Design and Methods Between July 2014 and December 2015 the directors of the National Institute of Nursing Research (NINR)-funded P20 and P30 centers of excellence and NINR staff met in a series of telephone calls and a face-to-face NINR-sponsored meeting to select a set of recommended CDEs to be used in self-management research. A list of potential CDEs was developed from examination of common constructs in current self-management frameworks, as well as identification of variables frequently used in studies conducted in the centers of excellence. Findings The recommended CDEs include measures of three self-management processes: activation, self-regulation, and self-efficacy for managing chronic conditions, and one measure of a self-management outcome, global health. Conclusions The self-management of chronic conditions, which encompasses a considerable number of processes, behaviors, and outcomes across a broad range of chronic conditions, presents several challenges in the identification of a parsimonious set of CDEs. This initial list of recommended CDEs for use in self-management research is provisional in that it is expected that over time it will be refined. Comment and recommended revisions are sought from the research and practice communities. Clinical Relevance The use of CDEs can facilitate generalizability of research findings across diverse population and interventions.

Purpose – Mentoring of junior faculty members (i.e. professors) in higher education has been documented to be critical to their academic success which most often takes the form of receiving tenure and/or promotion to higher academic ranks at universities in the USA. A “junior faculty member” would be defined as someone who has not yet been tenured or promoted and is usually within the first five years of their academic appointment. However, mentoring relationships can sometimes be difficult to build and momentum for continuous mentoring throughout the pre-tenure period can be a challenge to maintain. One of the concerns identified by mentees is the importance of regular meetings with mentors and the concomitant difficulty of knowing what to address in these meetings so as to make them productive and helpful. Mentors, most often senior faculty members, note that they do not always know the most relevant issues to discuss with junior faculty during mentoring meetings. The paper aims to discuss these issues. Design/methodology/approach – In an effort to address these issues, the authors describe here the development of using creative technology to support a new mentoring system that provides structured prompts and reminders to both mentors and mentees and uses tools to enhance the efficiency and effectiveness of the mentoring relationship. Findings – This paper highlights a pilot program, describing the rationale for and stages in the development of an e-mail-based and mobile-based program to improve the quality of mentoring for junior faculty at one higher education institution. Focus group data provided by stakeholders (e.g. faculty, department chairs, and associate deans) are provided. Originality/value – Professional development and academic success for junior faculty members may be strengthened by greater attention to formal mentoring strategies such as the one described here.

This qualitative study examines the role of communication among African American mothers living with HIV and their daughters in HIV prevention. Multiple themes emerged from our analysis of semistructured interviews with mothers (n = 15), and their adult daughters, (n = 15) such as perceptions of HIV risk communication, HIV/AIDS knowledge, attitudes, and beliefs. The findings of the study revealed differences in communication between mothers and daughters. Daughters felt they did not receive adequate and frequent HIV prevention advice from their mothers. Implications include strengthening communication content between mother-daughter dyads in HIV prevention programs that can aid in reducing HIV risk.

Past drug epidemics have disproportionately criminalized drug addiction among African Americans, leading to disparate health outcomes, increased rates of HIV/AIDS, and mass incarceration. Conversely, the current opioid addiction crisis in the USA focuses primarily on white communities and is being addressed as a public health problem. The 21st Century Cures Act has the potential to reduce racial health disparities in the criminal justice system through the Act's public health approach to addiction and mental health issues. The 21st Century Cures Act is a progressive step in the right direction; however, given the historical context of segregation and the criminalization of drug addiction among African Americans, the goals of health equity are at risk of being compromised. This paper discusses the implications of this landmark legislation and its potential to decrease racial health disparities, highlighting the importance of ensuring that access to treatment and alternatives to incarceration must include communities of color. In this paper, the authors explain the key components of the 21st Century Cures Act that are specific to criminal justice reform, including a key objective, which is treatment over incarceration. We suggest that without proper attention to how, and where, funding mechanisms are distributed, the 21st Century Cures Act has the potential to increase racial health disparities rather than alleviate them.

Self-care/self-management behaviors are extremely important in the older adult population to increase quality of life and general health. The overall goal of our Northeastern University Center on Technology in Support of Self-Management and Health, or NUCare, is to develop nursing research expertise and effective interventions in self- management for older adults at risk for poor health outcomes. We support this mission through a shared infrastructure that promoted the use of state-of-the-art technology to facilitate the timeliness, scalability and effectiveness of self-management interventions. Each presentation describes the results of an innovative technology-supported intervention to improve quality of life in older adults. Howard compares results of a comprehensive assessment and wellness coaching program in two diverse. Douglas presents a self-management intervention for older black women with high blood pressure using a smart phone application. Poghosyan explores the characteristics of a diverse group of current and former smokers and shares the results of a feasibility trial for a sensor-based intervention. Saczynski and Ramdin report on the feasibility of using a mobile cognitive assessment in atrial fibrillation patients. Ye shares preliminary results of a mobile-based dyadic intervention for individuals using CPAP therapy and their partners. The session chair will lead a discussion with the audience about the intersection of technology and nursing science.

Author(s): Chen, Wei-Ti; Guthrie, Barbara; Shiu, Cheng-Shi; Wang, Lixuan; Weng, Zhongqi; Li, Chiang-Shan; Lee, Tony Szu-Hsien; Kamitani, Emiko; Fukuda, Yumiko; Luu, Binh Vinh | Abstract: AimWe explored how acculturation and self-actualization affect depression in the HIV-positive Asians and Pacific Islanders immigrant population.BackgroundAsians and Pacific Islanders are among the fastest growing minority groups in the USA. Asians and Pacific Islanders are the only racial/ethnic group to show a significant increase in HIV diagnosis rate.DesignA mixed-methods study was conducted.MethodsThirty in-depth interviews were conducted with HIV-positive Asians and Pacific Islanders in San Francisco and New York. Additionally, cross-sectional audio computer-assisted self-interviews were conducted with a sample of 50 HIV-positive Asians and Pacific Islanders. Content analysis was used to analyse the in-depth interviews. Also, descriptive, bivariate statistics and multivariable regression analysis was used to estimate the associations among depression, acculturation and self-actualization. The study took place from January-June 2013.DiscussionMajor themes were extracted from the interview data, including self-actualization, acculturation and depression. The participants were then divided into three acculturation levels correlating to their varying levels of self-actualization. For those with low acculturation, there was a large discrepancy in the Center for Epidemiologic Studies Depression Scale scores between those who had totally lost their self-actualization and those who believed they could still achieve their 'American dreams'. Among those who were less acculturated, there was a significant difference in depression scores between those who felt they had totally lost their ability to self-actualize and those who still believed they could 'make their dreams come true.'ConclusionAcculturation levels influence depression and self-actualization in the HIV-positive Asians and Pacific Islanders population. Lower acculturated Asian Americans achieved a lower degree of self-actualization and suffered from depression. Future interventions should focus on enhancing acculturation and reducing depression to achieve self-actualization.

Background: Unequal human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) distribution is influenced by certain social and structural contexts that facilitate HIV transmission and concentrate HIV in disease epicenters. Thus, one of the first steps in designing effective community-level HIV/AIDS initiatives is to disentangle the influence of individual, social, and structural factors on HIV risk. Combining ethnographic methodology with geographic information systems mapping can allow for a complex exploration of multilevel factors within communities that facilitate HIV transmission in highly affected areas. Objectives: We present the formative comparative community-based case study findings of an investigation of individual-, social-, and structural-level factors that contribute to the HIV/AIDS epidemic among Black Philadelphians. Methods: Communities were defined using census tracts. The methodology included ethnographic and geographic information systems mapping, observation, informal conversations with residents and business owners, and secondary analyses of census tract-level data in four Philadelphia neighborhoods. Results: Factors such as overcrowding, disadvantage, permeability in community boundaries, and availability and accessibility of health-related resources varied significantly. Furthermore, HIV/AIDS trended with social and structural inequities above and beyond the community’s racial composition. Discussion: This study was a first step to disentangle relationships between community-level factors and potential risk for HIV in an HIV epicenter. The findings also highlight stark sociodemographic differences within and across racial groups and further substantiate the need for comprehensive, community-level HIV prevention interventions. These findings from targeted U.S. urban communities have potential applicability for examining the distribution of HIV/AIDS in broader national and international geosocial contexts.

Sexual assault (SA) is a major public health problem that leaves patients at risk for HIV. The gold standard of medical treatment for SA patients includes prophylactic treatment to prevent HIV. A meta-analysis was conducted and examined the rates of nonoccupational postexposure prophylaxis (n-PEP) offered to, accepted, and completed by SA patients who presented to emergency departments in the United States. Four points of data were analyzed: (a) SA patients who met the criteria and were offered n-PEP, (b) SA patients who were offered n-PEP and accepted the medication, (c) SA patients who accepted n-PEP treatment and completed at least one follow-up appointment, and (d) SA patients who completed the entire course of n-PEP. Results of the meta-analysis indicated that approximately half of the patients who were offered n-PEP accepted the medication. However, only 25.7% of SA patients who accepted n-PEP completed the full course.

HIV has reached epidemic proportions among African Americans in the USA but certain urban contexts appear to experience a disproportionate disease burden. Geographic information systems mapping in Philadelphia, indicates increased HIV incidence and prevalence in predominantly Black census tracts, with drastic differences across adjacent communities. What factors shape these geographic HIV disparities among Black Philadelphians? This descriptive qualitative study was designed to refine and validate a conceptual model developed to better understand multi-level determinants of HIV-related risk among Black Philadelphians. We used an expanded ecological approach to elicit reflective perceptions among administrators, direct service providers, and community members about individual, social, and structural factors that interact to protect against or increase the risk for acquiring HIV within their community. Gender equity, social capital, and positive cultural mores (e.g., monogamy, abstinence) were seen as the main protective factors. Historical negative contributory influences of racial residential segregation, poverty, and incarceration were the most salient risk factors. This study was a critical next step toward initiating theory-based, multi-level community-based HIV prevention initiatives.

Studies have indicated disproportionate health risks among African American adolescents. Given these estimates, research has focused on the prevention of health risk behaviors among this population. Using a strengths-based approach, the current study explored associations between community involvement and African American youths’ health risk behaviors. Additionally, this investigation examined youths’ empowerment beliefs as a mediator of this association. Participants in this study were 1,452 African American youth ( M = 14.41; SD = 1.14; 59% female) residing in a large Midwestern city. Results indicated that community involvement was not directly associated with adolescent health risk behaviors. However, empowerment beliefs mediated the association between community youth involvement and adolescent sexual risk behaviors. Findings suggest the importance of identifying mechanisms that better illuminate the link between community involvement and African American adolescents’ health risk behaviors.

African American youth continue to be disproportionately affected by HIV. Early sexual debut has been identified as a major determinant of HIV risk. However, emerging research suggests that the overarching context in which first sex occurs may have greater implications for sexual health than simply age alone. The purpose of this exploratory, qualitative study was to better understand the broader context of African Americans’ sexual debut. In-depth, semi-structured interviews were conducted with 10 African American men and women aged 18–24 years. Thematic analysis was used to analyze the data. The mean age at sexual debut for the sample was 15.4 (SD = 3.3), and youth framed their sexual debut as positive (50%), negative (30%), and both positive and negative (20%). The majority of youth initiated pre-sex conversations with their partners to gauge potential interest in engaging in sexual activity, and all youth utilized at least one HIV/sexually transmitted infection and pregnancy prevention method. However, most youth failed to talk to their partners prior to sex about their past sexual histories and what the experience meant for their relationship. Key differences emerged between youth who framed the experience as positive and those who framed the experience as negative or both positive and negative in terms of their motivations for initiating sex (i.e., readiness to initiate sex, pressure, and emotionally safety) and post-sex emotions (i.e., remorse and contentment). Findings provide further support for examining the broader sexual context of African American’s sexual debut. A more comprehensive understanding of sexual debut will aid in the development and tailoring of sexual risk reduction programs targeting African American youth.

Sixty percent of young adults living with HIV in the United States are unaware of their status despite recommendations to screen everyone. Effective approaches to encourage partner testing may increase status awareness. The purpose of our study was to understand young Black women's experiences when encouraging a partner to test for HIV, preferred approaches, and whether interpersonal context influenced the approach. Black women (n = 26) participated in the study in Boston-area focus groups (n = 6). Discussions ranged from difficult and stressful to positive and empowering. A variety of approaches (expressing caring, seeking understanding, leveraging the relationship, ultimatums, subtlety) were described in varied interpersonal contexts. Testing and sharing results fostered trust and relationship growth. If a partner was resistant, some ended relationships while others tested themselves and interpreted their results as their partners' status. Our findings could encourage HIV prevention initiatives to consider varied interpersonal contexts and enhance partner testing.

Background: Although the Kingdom of Saudi Arabia (KSA) began surveillance for human immunodeficiency virus (HIV) transmission in 1984, STI-related incidence and prevalence rates are unavailable for the larger Saudi population, and more specifically, for married Saudi Arabian women. Studies show that married Saudi Arabian women are at risk of contracting STIs from their husbands, but studies regarding married Saudi Arabian Women’s STI-related knowledge and attitudes are lacking because there is no valid and reliable quantitative measurement instrument available. The aims of this qualitative study were to explore the perceptions of married Saudi Arabian women’s knowledge and attitudes about the risk of becoming infected with STIs, and to generate themes needed to guide the development of a valid and reliable quantitative instrument that is culturally appropriate and gender-specific for married Saudi Arabian women. Methods: A grounded theory (GT) approach was used for data collection, guided by Bronfenbrenner’s Ecological Model. Married Saudi Arabian women over age 18 who had been living in the United States (US) for less than 18 months underwent private interviews about STI-related knowledge and attitudes. Themes resulting from the GT analysis were assembled into a framework. Results: Twelve participants were interviewed before saturation of themes was reached. The 153 codes identified were categorized and assembled into a hierarchical thematic framework. Eight themes pertinent to STI-related knowledge and attitudes were uncovered. Discussion: The results revealed that Saudi Arabian married women are aware that they are lacking knowledge about STIs, and would like more education and resources to provide this information. In addition, these women were concerned about prevention and treatment of STIs, not only personally, but in the community at large. The results of this study will be used as a basis to develop a quantitative instrument that focus on measuring the STI-related knowledge and attitudes of married Saudi Arabian women.

Purpose: This study built on previous findings and compared the effects of maternal influences on adolescents’ sexual initiation among four racial and ethnic groups: Asian American Pacific Islanders, African Americans, Hispanic Americans, and Caucasians. Design/Method: An exploratory, comparative secondary analysis of longitudinal data from 433 Asian American Pacific Islanders, 1,367 African Americans, 1,241 Hispanic Americans, and 4,567 Caucasian adolescents between the ages of 15 and 17 years at Wave 1 was conducted using structural equation modeling. Bronfenbrenner’s Social Ecological Model guided the modeling and analyses. Results: Adolescents’ sexual initiation was significantly associated with mother–adolescent interactions and adolescents’ perceived maternal sexual expectations. Cross-cultural variations are noted and discussed. Conclusions: Nursing interventions designed to delay adolescents’ sexual initiation need to focus on familial and cultural variations associated with mother–adolescent interactions.

The current investigation explores the promotive and protective role of family and community-specific social support on the association between perceived racial discrimination and African American adolescents’ adjustment (e.g., depressive symptoms, school suspensions, school engagement). One thousand nine-hundred forty-two African American adolescents (ages 12–18, M = 15.12; SD = 1.83; 59 % female) from a large Midwestern city participated in this investigation. Regression analyses revealed that perceived racial discrimination was associated with less positive adjustment outcomes for boys and girls. Additionally, there was partial support for gender variation in the promotive role of social support and adolescent adjustment. In particular, while only maternal support was associated with boys’ adjustment, both maternal and paternal support was associated with girls’ adjustment. Also, there was partial support for gender differentiation in the strength and directionality of protective factors. Though in an unpredicted direction, father support moderated the relationship between perceived racial discrimination and girls’ adjustment. Community supports (religious connection and mentor presence) emerged as protective factors for boys’. Findings highlight the role of gender in understanding potential promotive and protective factors for African American adolescents.

Infectious and chronic diseases are disproportionately greater among detained women than among women in the population at large. The overall punitive, male-based, one-size-fits-all approach to health care and the variant overall health care standards across correctional systems call for a new model of correctional health care. The assumptions, constructs, strategies, and future research implications of the restorative health care model are described.

Given that stressors may accumulate across the life span, the extent to which daily hassles are associated with African American females’ psychological functioning during the adolescent years remains an important question. Understanding the potential impact of daily hassles is important due to indications that African American women report greater daily hassles and have higher incidence rates of stress-related disorders. The current study examines the relationship between daily hassles and psychological functioning (e.g., depression and anxiety symptoms) among 103 U.S. African American adolescent females (M = 15.50; SD = 1.70) residing in a moderately-sized Midwestern city. Additionally, this investigation explores gender role orientation as a moderator of this relationship. Results indicated that increased daily hassles were associated with greater depressive and anxiety symptoms. Also, this investigation provides some support for the direct and moderating role of gender role orientation. A greater feminine or androgynous role orientation was associated with fewer depressive and anxiety symptoms. In addition, although not directly associated, this investigation indicated that a masculine role orientation moderated the association between daily hassles and girls’ psychological outcomes. Specifically, among African American adolescent females with a greater masculine role orientation, increased daily hassles were associated with reduced psychological functioning (e.g., greater depressive and anxiety symptoms). Neither feminine nor androgynous role orientation, however, moderated the relationship between daily hassles and psychological functioning (e.g., depressive and anxiety symptoms). Implications of findings are discussed.

An ecological framework provides the underpinnings for the examination of factors associated with the health-promoting and health-compromising behaviors of African American adolescent females (N=137). Findings indicate that more positive family, peer, and neighborhood factors were associated with less engagement in health-compromising behaviors and increased engagement in health-promoting behaviors. Also, more positive family interactions buffered the relationship between neighborhood characteristics and adolescents' engagement in health-compromising behaviors. Overall, the findings suggest that the health-related behaviors of African American adolescent females are best understood in the context of their social relationships and environmental contexts.

This article critically reviews the literature about adolescent males’ sexuality in order to describe the state of the science and to identify promising concepts and research designs that have the potential to guide the next generation of research. A critique was conducted on 94 peer-reviewed studies of sexual behaviors that included a sample of adolescent males; 11 scholarly texts and 2 dissertations. Most studies lacked a theoretical foundation and had cross-sectional designs. For those studies with a theoretical base, 3 perspectives were most often used to guide research: cognitive, biological, or social-environmental. Studies frequently relied on older adolescents or young adult males to report behaviors during early adolescence. Male-only samples were infrequent. Findings include (a) the measurement of sexual activity is frequently limited to coitus and does not explore other forms of “sex”; (b) cognitive factors have been limited to knowledge, attitudes, and intent; (c) little is known about younger males based on their own self-reports; (d) little is known about the normative sexuality development of gay adolescent males; and (e) longitudinal studies did not take into account the complexities of biological, social, and emotional development in interaction with other influences. Research on adolescent sexuality generally is about sexual activity, with little research that includes cognitive competency or young males’ sense of self as a sexual being. The purpose of the paper is to critically review the literature about male sexuality in order to describe the state of the science as well as to identify potential directions to guide the next generation of adolescent male sexual being research.

Professional standards require culturally competent care, but competencies are rarely assessed. An instrument adapted from the work of cultural competence experts was used to assess the cultural competence of nurse practitioner students ( n = 122). The 30-item instrument indicated adequate reliability scores (.78 to .87). Students reported high levels of comfort with people who are different from themselves and felt that cultural knowledge was important. Students scored fairly low on engaging in community-related culturally relevant behaviors. Predictors of culturally competent behaviors in clinical practice and the community were: comfort with others who are different from themselves, the degree of importance attached to cultural knowledge, and likelihood of future practice in rural areas. Nurse practitioner programs need to concentrate on increasing students' comfort with culturally diverse client groups and stressing a deeper cultural knowledge in clinical practice.

Most of what is known about the meaning women assign to the experience of childbirth in the United States is based primarily on studies of Euro American, highly educated, married women of middle to higher income levels. Yet almost half a million adolescents give birth annually. This exploratory, qualitative study was conducted with 25 adolescents in an alternative school, partnered with the juvenile justice system, who had given birth. An open-ended question format was used for the interviews, and analysis was conducted by using extended case methodology. The study revealed a number of differences between the existing literature reports about women’s interpretations of birth and the meanings assigned to childbirth experiences by the adolescents in this study. A key difference was the relationship between the pain of childbirth and responsibility for their child. The results provide an entree into understanding unique characteristics of giving birth as an adolescent and potential roles health care providers can play to promote a positive experience.

Asians and Pacific Islanders (API) are among the fastest growing minority groups within the USA, and this growth has been accompanied by an increase in HIV incidence. Between 2000 and 2010, the API HIV infection rate increased from 4.5% to 8.7%; however, there is a paucity of HIV-related research for this group, and even less is known about the prevalence and correlates of antiretroviral therapy adherence behavior, quality of life, impact of stress, and efficacious self-management among HIV+ API Americans. This paper examines how acculturation and perceived stress affect depression symptomatology and treatment seeking in the HIV+ API population. A series of cross-sectional audio computer-assisted self-interviews were conducted with a convenience sample of 50 HIV+ API (29 in San Francisco and 21 in New York City). The relationship between acculturation and perceived stress was analyzed, and the results indicate that for those HIV+ API who reported low or moderate acculturation (as compared to those who reported high acculturation), stress was significantly mediated by depression symptomology. Interventions to address acculturation and reduce perceived stress among API generally and Asians specifically are therefore needed. © 2014 © 2014 Taylor & Francis.

A brief overview and history of the Female Adolescent Initiative, a program funded by the Center for Substance Abuse Prevention, is given. Findings from selected programs and a synthetic summary of what the program interventionists learned are presented. The authors use the results from these programs to develop a framework to guide the next generation of scholars who focus on gender-specific substance abuse prevention and provide specific suggestions for designing the next generation of gender-specific programs.

This paper presents a conceptual framework derived from theorists of female developmental and psychoanalytical psychology which explains the various health concerns of adolescent females. These health concerns include the specific mental health-related issues for young girls such as depression and eating disorders. It also attempts to link the developmental transition of these young girls to these health issues as well as examine the impact of race ethnicity and socioeconomic status. Based on the discussions several strategies for health promotion are developed using the constructs of relationship and voice. First health promotion in pregnancy drug use eating disorders and depression should be addressed in the developmental framework specifically theorized for young girls. Second a diverse group of professionals should be recruited to develop programs in schools and communities.

To determine: (1) the frequency of risky behaviors (alcohol and other drug use, smoking cigarettes, smokeless tobacco use, and unprotected intercourse); (2) the perception of general risks and diabetes-related risks from risky behaviors; (3) if perception of risk is related to engaging in risky behaviors; and (4) if perception of general risks and diabetes-related risks are influenced by age, gender, or race in adolescents with insulin dependent diabetes mellitus (IDDM). Decreasing risky behaviors in youth with IDDM is important because of their increased vulnerability to specific disease related physiologic and pathologic changes.A descriptive, cross-sectional design was used. Data on risky behavior and perception of risk were obtained by self-report during a regularly scheduled clinic visit. One hundred and fifty-five adolescents between ages of 10-20 years participated. Correlational and student's t-test analyses were used to test relationships and group differences (age, race, gender).Thirty-nine percent of the sample reported alcohol use, 34% reported smoking cigarettes, 8% reported smokeless tobacco use, 10% reported drug use, and 29% reported unprotected intercourse. Perception of risk to peers from these behaviors was significantly higher (t = 8.1, df 153; p.001) than risk to self. Females reported significantly lower (t = 3.08, df 52; p.002) risk to self than males. There was no difference in perception of risk between youth who reported participating in risky behaviors (N = 38%) and those who did not (62%). Not surprisingly, the frequency of risky behavior increased with age (F = 15.46; p.001).Compared to community samples of middle school children, our sample had lower rates for most risky behaviors. As with community samples, the physical risks were known and perceived to be higher for peers than self. Perception of risk was not related to self-reports of risky behaviors. The lower rate of risky behaviors might reflect the success of educational efforts directed toward diabetes management or may be due to later initiation of behaviors, especially if personal social development is delayed. Additional research is indicated in order to understand the timing and trajectory of risky behavior and whether or not perception of risk deters youth with IDDM from engaging in risky behavior.

The number of adolescent females between the ages of 13 and 19 who are contracting sexually transmitted diseases (STDs) is rising at an alarming rate. Although the issue of STDs has been overshadowed by continued public debate over adolescent pregnancy and childbearing, it demands attention. Particularly concerning is the fact that STDs increase the likelihood of transmitting HIV (N.E. MacDonald et al., 1990). To offset the growing incidences of STDs among female adolescents, gender-specific interventions are needed. Following is a description of the theoretical underpinnings that informed and guided the development of a gender-specific intervention titled Girl Talk. A two-stage creation and review process was used to design this 2.5-hr, four-session intervention. An overview of the quasi-experimental design that compared a nonequivalent comparison and two intervention groups (peer led and adult led) is presented. Baseline characteristics of the three groups are reported. Also described is how participant feedback and a design content analysis are used to evaluate the appropriateness of the intervention for adolescent females.

Given the increase in the number of female youth who come in contact with the juvenile justice system, particularly those from ethnic minority backgrounds, concerns have been raised about the health status of this population. Using a latent profile analysis, we identified health profiles using indicators of psychological well-being, health risk behav- iors, and health status. Participants included 153 minority adolescent females (M15.13, SD1.70) who were currently in a juvenile diversion program. Results indicated that a three-class solution fit the data optimally. Profiles included girls with low to moderate health risks (n35; 22.9%), higher mental health symptoms (n68; 44.4%), and a combi- nation of multiple health risks (n50; 32.7%). Additionally, demographic, contextual and offense-related variation existed across health profiles. Treatment and policy implications are discussed.

Maternal influences on adolescents’ sexual initiation have been examined over two time points in 433 Asian American—Pacific Islander (AAPI) adolescents in a secondary analysis of the Add Health data set using structural equation modeling. A longitudinal model built on a preliminary qualitative study is used to examine the fit between data and model. Maternal perceived connectedness and adolescents’ perceived maternal sexual expectations in sexual timing are found to be protective for delaying AAPI adolescents’ sexual initiation. Unexpectedly, mothers’ perceptions of sexual discussion are not protective for delaying adolescents’ sexual initiation. The results suggest interventions should focus on promoting AAPI mothers’ perceptions of connectedness with their adolescents and adolescents’ perceptions of their mothers’ sexual expectations (as measured by adolescents’ perceived maternal disapproval attitudes and affects) in delaying sexual initiation.