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Study Objective The purpose of this study was to examine feasibility, acceptability, and preliminary efficacy of a mindfulness-based healthy lifestyle self-management intervention with adolescents and young adults diagnosed with polycystic ovary syndrome (PCOS). Design A pilot randomized controlled trial using a pre-post design was used. Setting Central Texas. Participants: Individuals aged 14-23 with a diagnosis of PCOS. Interventions The PCOS Kind Mind Program integrates a manualized mindfulness training program (Taming the Adolescent Mind) with health education in four key areas of self-management and health promotion; (1) medication adherence, (2) nutrition, (3) physical activity, and (4) sleep. Main Outcome Measures Psychological distress, mindfulness, physical activity strategies, nutrition and exercise self-efficacy. Results Linear regression models revealed that those in the PCOS Kind Mind condition reported significantly higher nutrition self-efficacy (β = 6.50, 95% CI = 1.71 – 11.28, p = 0.013, d = 0.48), physical activity strategies (β = 0.41, 95% CI = 0.04 – 0.79, p = 0.040, d = 0.67), and physical activity self-efficacy (β = 0.48, 95% CI = 0.07 – 0.88, p = 0.028, d = 0.46). Conclusion The PCOS Kind Mind Program improved self-efficacy in the key areas of nutrition and physical activity and increased physical activity strategies in adolescents and young people with PCOS. These findings are encouraging and suggest the need for larger scale, randomized controlled trials with longer-term follow-up in order to more robustly evaluate the PCOS Kind Mind Program on the psychological and physiological health of adolescents and young people with PCOS.

BACKGROUND/OBJECTIVES: We sought to quantify the reliability and validity of remote atopic dermatitis (AD) severity assessment using the Eczema Area and Severity Index (EASI) applied to caregiver-provided photos (p-EASI) and videos (v-EASI). METHODS: Children (0–17 years) with a physician diagnosis of AD were recruited. Caregivers took photos and a video of their child’s skin. A clinician scored in-person EASI on the same day, then p-EASI and v-EASI for each participant ten days or more between ratings. Two additional clinicians scored p-EASI and v-EASI. Lin’s concordance correlation coefficient (CCC) was employed to assess criterion validity using in-person EASI as the gold standard. Intraclass correlation coefficients (ICC) were calculated to assess interrater reliability of p-EASI and v-EASI. RESULTS: Fifty racially and ethnically diverse children (age (mean±SD): 4.3±4.4 years; 42% female) with a range of AD severity (EASI: 6.3±6.4) and Fitzpatrick Skin Types (1–2: 9%; 3–4: 60%; 5–6: 31%) were enrolled and received in-person EASI assessment. Fifty had p-EASI and 49 had v-EASI by the same in-person rater, and by two additional raters. The CCC and ICC for p-EASI were 0.89, 95% CI [0.83, 0.95]; and 0.81, 95% CI [0.71, 0.89], respectively. The CCC and ICC for v-EASI were 0.75, 95% CI [0.63, 0.88]; and 0.69, 95% CI [0.51, 0.81], respectively. CONCLUSIONS: In this diverse population with a range of skin tones, p-EASI showed good criterion validity and good interrater reliability. v-EASI showed moderate to good criterion validity and moderate interrater reliability. Both may be reliable and valid options for remote AD severity assessment.

Societal trends and COVID-19 quarantines have increased the number of adolescents experiencing social isolation, placing them at heightened risk for mental health issues. The aim of this review is to explore protective factors that might mitigate psychological harm in the presence of social isolation. A systematic literature review was conducted using Fink's step-by-step process. Four library databases were searched, and results were reported using PRISMA. Of the 246 studies reviewed, 12 studies were retained following the quality assessment. The sample includes 14,064 participants from USA, Australia, and Europe, ranging from 10-19 years old. Social connectedness (ie., family connectedness, school connectedness, social support), self-esteem, and prosocial behaviors were the most common protective factors to social isolation. Additional factors such as self-efficacy, optimism, and ethnic identity are discussed. Implications for future research are recommended, including the need to explore spiritual, biological, and sociocultural factors influencing social connectedness and mental health in adolescents.

Mental health issues have been exacerbated by COVID-19; therefore we examined how the school nurses’ role in addressing mental health changed during the pandemic. We administered a nationwide survey in 2021, guided by the Framework for the 21st Century School Nurse, and analyzed self-reported changes in mental health interventions by school nurses. Most mental health practice changes after the start of the pandemic occurred in the care coordination (52.8%) and community/public health (45.8%) principles. An overall decrease in students visiting the school nurse’s office (39.4%) was seen, yet the frequency of students visiting with mental health concerns had increased (49.7%). Open-ended responses indicated that school nurse roles changed due to COVID-19 protocols, including decreased access to students and changes in mental health resources. These insights into the role of school nurses in addressing student mental health during public health disasters have important implications for future disaster preparedness efforts.

Nursing research involves much planning and attention to details, yet novice and seasoned nurse researchers often overlook the day-to-day operations required to conduct research studies. Project management is a set of iterative steps that can facilitate the process of conducting nursing research. In this paper we aim to provide an overview of project management and identify ways in which its specific principles and strategies may be applied to facilitate nursing research. Here we give an overview of our current longitudinal study using a Solomon four-group design and illustrate how we applied strategies and tools from the project management literature. In addition, we offer descriptions and illustrations of several other project management tools that could have been used in specific phases of this research project. We encourage nurse educators and researchers to familiarize themselves with the principles of project management and consider using them in future studies.

INTRODUCTION: Atopic dermatitis (AD) is a common chronic childhood illness. It is often treated by primary care providers (PCPs) though may require referral to a dermatology specialist. METHODS: We administered an exploratory survey to 50 caregivers of children ages 0 – 17 years with AD to assess their preferences and barriers toward accessing dermatology specialty care for their child’s AD. RESULTS: Caregivers felt PCPs and specialists equally listened to concerns about their child’s AD. However, many felt there was a difference in the care provided and control of the AD and preferred to see a specialist for ongoing management. DISCUSSION: Caregivers may benefit from their children being referred to dermatology specialists earlier and more often for their AD. Further work must be done to characterize preferences and barriers toward AD care across race and ethnicity.

Psychological capital (PsyCap) is a term coined in organizational psychology and refers to a person’s development of states that motivate behavior. Also known in the literature as PsyCap, this construct typically refers to positive states of hope, self-efficacy, resilience, and optimism that are amenable to intervention and that are related to subjective well-being and life satisfaction. The aims of this systematic scoping review were to explore how PsyCap is described in youth mental health literature and how PsyCap and mental health are related. Results from four databases were reported following PRISMA guidelines. A total of 772 studies were identified and 16 studies were fully reviewed, including an overall sample of 6,772 youth from six countries. PsyCap has a positive relationship with mental health in youth. Future studies should involve school nurses to validate the constructs that characterize PsyCap and validate an instrument for measuring PsyCap in youth mental health in English.

School nurses represent cost-effective investments in students’ health and educational success. Alternative high schools (AHSs) serve an understudied population of youth who are at risk for school dropout and face numerous social inequities, heightening their risk for poor health outcomes. In this two-phase explanatory sequential mixed methods study, we examined school nurse staffing in Texas AHSs. Findings suggest Texas AHSs face understaffing for familiar reasons common across districts (e.g., lack of funding), but also reveal potential deeper inequities. Quantitative findings indicate 71% of Texas AHSs have some form of nursing support, most often an on-call or part-time nurse. Qualitative findings support and enrich this finding with insights into the negative consequences of not having a full-time nurse, indiscriminate approaches to staffing AHSs, and how AHSs can be the only school in the district without a full-time nurse. Altogether, our findings reveal opportunities to better support AHSs with adequate nursing support.

Purpose Already at high-risk for adverse consequences associated with daily living, youth experiencing homelessness face additional barriers to health and well-being during the COVID-19 pandemic. The purpose of this study was to identify the self-reported experiences and healthcare needs of youth experiencing homelessness as services in the community began to shut down at the beginning of the pandemic. Method From May through November 2020, qualitative data were obtained by telephone or Facebook messenger from 20 youth (M = 22.4, SD = 2.64 years) who had been enrolled in a longitudinal intervention study. Results Content analysis of qualitative data yielded 5 categories and 1 overall theme. Categories were resource availability, financial instability, mental health, relationship conflict, and maladaptive coping. The overall theme was multiple losses. Youths lost jobs, means of financial support for self and family, access to social and healthcare services, meaningful and important relationships, and skills and controls over high-risk behaviors such as substance abuse. Conclusions Having similar experiences such as social isolation as those of high school students during the pandemic, the youths in this sample experienced multiple and simultaneous losses, needing time to grieve, and leaving them once more at high-risk for adverse outcomes.

Parents of young children have unique informational needs and it has been demonstrated that information-seeking behaviors influence health outcomes. Due to social media’s popularity, understanding parents’ use of social media may assist in disseminating accurate parenting information and in developing targeted interventions. Thus, we aimed to identify and describe the existing literature of parental use of social media for parenting in the U.S. After searching nine databases with two separate Boolean phrases, identified articles were reviewed. Inclusion and exclusion criteria were applied, resulting in 12 articles published between January 2004 and May 2018 that related to parental use of social media for parenting or infant health in the U.S. Data from relevant articles were then extracted and analyzed. Facebook was the most frequent social media format. Parental utilization of social media varied by race/ethnicity and region. Studies primarily focused on women and a range of article topics were identified, the most common being infant feeding practices. Finally, two themes emerged: (1) parental support via social media and (2) effectiveness of using social media for health communication targeting parents. Social media provided support for parents and was effective for communicating health information; thus, public health organizations should include social media in their efforts to promote infant and child health. More research is needed to further identify demographic differences in social media use among parents.

The purpose of this secondary analysis of data from an ongoing, longitudinal intervention study for homeless youths (ages 18–24 years) was threefold: (1) to differentiate by age, sex, and sexual orientation, the positive attributes of hope, optimism, resilience, future time perspective, and gratitude, (2) to determine how these positive attributes might be related to life satisfaction, and (3) to determine which set of variables might best explain life satisfaction. We found a statistically significant difference in resilience scores by sex, H(2) = 6.591, p = .037, with males scoring higher than females. None of the other positive attributes differed significantly by sex. Future time perspective (FTP) differed significantly by sexual orientation with lesbian, gay, bisexual, and transgender (LGBT) youth scoring higher than others on FTP (p = .046). All theoretical variables (hope, optimism, FTP, resilience, and gratitude) were significantly related to life satisfaction (p

We compared sexual/reproductive health services and sexuality education topics provided in Texas alternative high schools (AHSs) with the prevalence of sexual risk behaviors among students in AHS. Using cross-sectional data from convenience samples of 14 principals, 14 lead health educators, and 515 students, we calculated descriptive statistics for 20 services and 15 sexuality education topics provided by AHSs and seven sexual risk behaviors among students in AHS. AHSs provided few sexual/reproductive health services and limited educational content, despite high levels of sexual risk taking among students. For example, no AHSs taught students about proper condom use, yet 84% of students have had sex. Findings provide preliminary evidence of unmet needs for school-based sexual/reproductive health services and comprehensive sexuality education in AHS settings. Future investigation with larger, representative samples is needed to assess the provision of sexual/reproductive health services and sexuality education in AHSs and monitor sexual risk behaviors in the AHS population.

Approximately 13% of United States (US) children have atopic dermatitis (AD), also known as eczema. AD is a chronic skin condition associated with significant burdens on quality of life and both individual and overall health-care system costs. The pathogenesis of AD is considered to be multifactorial, with biologic factors such as family history and genetics often reported as influencing risk. Some lesser discussed determinants of AD prevalence and severity are sociocultural, such as race/ethnicity, neighborhood, housing type, income level, and family structure. While several factors appear to contribute to disparities in childhood AD, black or African American race/ethnicity most significantly predicts AD prevalence, severity, disease control, access to care, and family impact. There is a shortage of research related to disparities in AD, an important topic considering the large percentage of families that are affected by the disease. This article is a narrative literature review of sociocultural influences on AD disparities in US children. The purpose of this review is to increase awareness of these important risk factors and to suggest related, future areas of research that may positively impact overall outcomes in children with AD. Much work remains to be done in order to ensure equitable care and outcomes among all children with AD.

Background Increasingly, early adolescents who are transgender or gender diverse (TGD) are seeking gender-affirming healthcare services. Pediatric healthcare providers supported by professional guidelines are treating many of these children with gonadotropin-releasing hormone agonists (GnRHa), which reversibly block pubertal development, giving the child and their family more time in which to explore the possibility of medical transition. Methods We conducted a critical review of the literature to answer a series of questions about criteria for using puberty-blocking medications, the specific drugs used, the risks and adverse consequences and/or the positive outcomes associated with their use. We searched four databases: LGBT Life, PsycINFO, PubMed, and Web of Science. From an initial sample of 211 articles, we systematically reviewed 9 research studies that met inclusion/exclusion criteria. Results Studies reviewed had samples ranging from 1 to 192 (N = 543). The majority (71%) of participants in these studies required a diagnosis of gender dysphoria to qualify for puberty suppression and were administered medication during Tanner stages 2 through 4. Positive outcomes were decreased suicidality in adulthood, improved affect and psychological functioning, and improved social life. Adverse factors associated with use were changes in body composition, slow growth, decreased height velocity, decreased bone turnover, cost of drugs, and lack of insurance coverage. One study met all quality criteria and was judged 'excellent', five studies met the majority of quality criteria resulting in 'good' ratings, whereas three studies were judged fair and had serious risks of bias. Conclusion Given the potentially life-saving benefits of these medications for TGD youth, it is critical that rigorous longitudinal and mixed methods research be conducted that includes stakeholders and members of the gender diverse community with representative samples.

Purpose To determine the state of science of outpatient- or community-based interventions for sudden infant death syndrome prevention in the United States, an integrative review was completed and studies identified through the application of inclusion and exclusion criteria. Conclusions Of the nine studies identified, three were randomized controlled trials. There was a wide range of measurement tools and variables measured. The timing of interventions also varied. There was a focus on mothers and African Americans. Lastly, study design and approach have not changed significantly over time. Practice implications Findings highlight recommendations for future research: expanding the target population, addressing culture in the development of the intervention or program, including additional providers, such as nurses, in the intervention or program, advancing innovation, and increasing rigor of study design.

BackgroundCultural awareness and cultural competence have become important skills in higher education as populations continue to grow in diversity around the world. However, currently, there are few instruments designed to assess student awareness of the aspects of culture, and the existing instruments need further development and testing for use with different target populations. Therefore, the aim of this study was to test the psychometric properties of a modified version of the Cultural Awareness Scale (CAS) for use in higher education within the health and social care fields.MethodsA modified version of the CAS was developed, which was tested psychometrically using cross-sectional data. In total, 191 undergraduate students from different health and social care undergraduate programs in Sweden and Hong Kong responded to a call to test the modified instrument.ResultsThe results showed that the modified CAS is a four-factor measure of cultural awareness and possesses satisfactory internal consistency. Results also support the use of the modified CAS as a generic tool to measure cultural awareness among students in higher education within the health and social care fields.ConclusionThe modified CAS showed satisfactory psychometric properties and can be recommended as a generic tool to measure cultural awareness among students in higher education within the health and social care fields. However, further psychometric testing on the effectiveness of the modified CAS as a tool to evaluate the efficacy of cultural awareness interventions is required.

This systematic literature review addresses risk and protective factors associated with suicidal ideation and attempts in young men who have sex with men (YMSM). The Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, PsychArticles, and PsychInfo yielded 14 articles. Risk factors included (1) not being enrolled in school, (2) earlier sexual debut, (3) substance use/abuse, (4) homelessness, (5) bullying and victimization, (6) fear of community violence, (7) and parental abuse. Protective factors included (1) positive sexual minority LGBT stereotypes, (2) family acceptance, (3) school and peer support, (4) high self-esteem, and (5) adaptive coping mechanisms.

Alternative high school (AHS) students are at-risk for school dropout and engage in high levels of health-risk behaviors that should be monitored over time. They are excluded from most public health surveillance efforts (e.g., Youth Risk Behavior Survey; YRBS), hindering our ability to monitor health disparities and allocate scarce resources to the areas of greatest need. Using active parental consent, we recruited 515 students from 14 AHSs in Texas to take a modified YRBS. We calculated three different participation rates, tracked participation by age of legal consent (≥18 and

Sexual health and sexual rights are integral to nursing science but ignored in nursing publications. We searched Advances in Nursing Science for prevalence of these topics. Fifteen articles (1.3%) met our criteria. No nursing theories were used as frameworks, and few concrete suggestions were made for further theory development. Discussion of sociopolitical influences on sexual health and/or sexual rights was limited, mostly unrelated to health care. Information to influence nursing practice, theory development, further research, or policy across the life span, for both males and females, and for variant-gender individuals, was limited. We urge authors to contribute further to this field of discourse in nursing.

Polycystic ovary syndrome (PCOS) is highly prevalent and increasingly diagnosed during adolescence. This study explored the context and processes of self-management among adolescents, and parents of adolescents, who have PCOS. Adolescents with PCOS (n=7) and their parents (n=8) participated in a series of focus groups. Deductive thematic analysis was guided by the Individual and Family Self-Management Theory (IFSMT; Ryan & Sawin, 2009), and the patterns that were identified aligned with the contexts and processes described therein. A secondary inductive approach was employed as a novel contextual pattern emerged: psychological health and well-being. Study findings suggest that adolescents and their families have a desire to engage in optimal self-management, and particularly effective strategies may consider a holistic, family intervention approach that addresses psychological health and well-being in addition to behavior change. Study findings are the first to reflect the unique needs of adolescents with PCOS and their families.

PURPOSE: Assess the context of psychological distress, violence, and substance use among African- and Mexican-American adolescent women with a history of STI, violence, or high sexual risk behavior. These adolescents experience multiple health disparities, limited access to care, and are at particularly high risk of adverse sexual health outcomes. The results will inform sexual health promotion interventions provided by advanced practice nurses in primary care-based settings for women experiencing these disparities. METHODS: Analysis of self-report data obtained at study entry from African- and Mexican-American adolescent women (n = 559) enrolled in a randomized trial of a behavioral intervention for sexual risk reduction. CONCLUSIONS: High levels of psychological distress, sexual risk behavior, sexually transmitted infection (STI), personal and friend/peer substance use, alcohol use, and violence were reported by women at study entry. Analyses found that STI, physical violence, and substance-using friends were twice as likely associated with personal substance use. Alcohol users were five times more likely to use other substances. Mexican Americans were three times more likely than African Americans to use substances. IMPLICATIONS FOR PRACTICE: Recommendation is made for integration of multicomponent sexual health promotion interventions as advanced practice nurse provider services addressing these health disparities within primary care-based settings. Language: en

Background: Homeless and street-dependent youths experience myriad stressors, but to date there has been no published measure of this phenomenon.Objective: This study was designed to describe the process of developing and testing a measure of stress experienced on the streets suitable for use with this population.Methods: Classical measurement theory was used to develop and evaluate relevance and validity of items in the scale.Results: The total scale content validity index was .95 and the Cronbach’s alpha was .92 in a combined sample of homeless youths (n = 90) and university students (n = 94). The mean scores of the two subsamples were statistically significantly different (t(166) = 4.22, P

There is a well-established link between educational attainment and health. Alternative high schools (AHSs) serve students who are at risk for school dropout. Health-related research conducted in AHSs has been sparse. Achieving high participation rates is critical to producing generalizable results and can be challenging in research with adolescents for reasons such as using active consent. These challenges become greater when working with vulnerable populations of adolescents. In this systematic review, we examined health-related studies conducted in AHSs between 2010 and 2015. Results indicated that (1) health-related research in AHSs has increased over the past 5 years, (2) AHS students continue to experience significant disparities, (3) active consent is commonly used with AHS students, (4) 42% of studies reported participation rates or provided enough information to calculate participation rates, and (5) school nurses are missing from health-related research conducted in AHSs. Implications for future research and school nursing are discussed.

Sudden unexplained death in infancy, including sudden infant death syndrome (SIDS), is a global public health challenge. Despite public health campaigns and efforts, SIDS remains the leading cause of postneonatal mortality in many developed countries. In this article, we review SIDS, describe nursing's unique professional position in addressing this problem, and explore how the principles of social justice can inform nursing's response. Motivated by nursing's ethical and moral obligations, the profession is called to take an active role in educating others regarding this phenomenon, to participate in research, and to develop or advocate for policy that aims to reduce the incidence of SIDS on an international scale.

Intervention fidelity is an ongoing concern for rigorous research, from the initial stages of planning and study design to the maintenance of internal validity. An added concern is the balance between fidelity and design accommodation to better suit varied populations and individuals. In this article, we describe our process for monitoring intervention fidelity during an individualized, yet standardized, strengths-based intervention with homeless youths, in which we include periodic training of our professional intervention facilitators. In our ongoing study, which is based on a Solomon four-group design with repeated measures, monitoring and training are essential to ensure intervention fidelity. Despite a rich literature about intervention fidelity, little guidance is available to help researchers and practitioners implement fidelity strategies in the real world with vulnerable populations. This article addresses this gap.

Purpose To test the effects of 2 modes of delivering an asthma educational intervention on health outcomes and asthma self-management in school-aged children who live in rural areas. Methods Longitudinal design with data collected 4 times over 12 months. The target sample was composed of children in grades 2-5 who had a provider diagnosis of asthma. Elementary schools were stratified into high or low socioeconomic status based on student enrollment in the free or reduced-cost lunch program. Schools were then randomly assigned to 1 of 3 treatment arms: in-school asthma class, asthma day camp, or the attention-control group. Findings Sample retention was good (87.7%) and equally distributed by study arm. Improvements in emergency department visits and office visits were related to attending either the asthma class or asthma day camp. Asthma severity significantly decreased in both asthma treatment groups. Other factors such as hospitalizations, parent asthma management, and child asthma management improved for all groups. Conclusions Both asthma class and asthma day camp yielded significant reductions in asthma severity. There were reductions in the emergency department and office visits for the 2 asthma arms, and hospitalizations declined significantly for all groups. Asthma self-management also improved in all groups, while it was somewhat higher in the asthma arms. This may be due to the attention being drawn to asthma management by study participation and the action of completing questionnaires about asthma management, asthma symptoms, and health outcomes.

This study had two purposes: (i) to explore differences in sexual function between women with gynecological or rectal cancer after related pelvic-area treatments and women without cancer; and (ii) to investigate the relationships among body image, anxiety and depression, sexual relationship power, sexual self-schema, and female sexual function. The participants (n = 139) were recruited through Internet cancer support groups and women's health organizations in the USA. Six structured questionnaires were mailed, and the data were analyzed using descriptive and inferential statistics. The results showed that women with gynecological or rectal cancer had significantly worse sexual function than women without cancer. Having gynecological/rectal cancer and a negative sexual self-schema were significantly related to poor sexual function. Furthermore, sexual self-schema moderated the relationship between sexual relationship power and female sexual function. Healthcare providers could give more attention to sexual issues in women who have undergone treatment for gynecological or rectal cancer, especially for those with a negative sexual self-schema and high sexual relationship power, which might improve these women's quality of life.

Homeless young adults are one of this country's most vulnerable populations, and information surrounding issues of subjective well-being among this particularly diverse population is scarce. The purpose of this study was to examine the impact social support, future expectations, and homeless cultural factors have on subjective well-being among homeless young adults. A purposive sample of 185 homeless young people, ages 18 to 23, and known to use alcohol or drugs, participated in the study. Multiple regression analyses showed that participants who had a higher level of subjective well-being reported significantly higher levels of social support, more optimistic expectations of the future, and a better perception of the flow of time. More fatalistic views of the future significantly predicted lower levels of subjective well-being. Findings suggest that service providers should focus on understanding the strengths of individuals and, specifically, gain a deeper understanding of homeless young adults' support networks and views of the future.

Purpose: Evidence suggests that the construct of ethnic identity (EI) in adolescents changes over time and is related to factors including social connectedness, social competence, coping, and self-worth. Transitional changes of EI in middle adolescence have not been studied. Method: This analysis, part of a longitudinal study of health behaviors, explored how EI changes from the first year of high school to the last, and it examined relationships among EI, social connectedness, indicators of social competence, coping, and self-worth in 602 youth (49% Hispanic, 59% female). Results: EI was significantly related to social connectedness, social competence, coping, and self-worth as adolescents entered and prepared to exit high school. EI increased significantly over time for both genders and for Hispanics more so than for non-Hispanics. Discussion: Findings support and extend the conceptual framework and previous research. Socialization with one’s ethnic group is associated with developing competence and self-worth. EI development continues throughout high school. Conclusion: Findings extend our understanding of the salience of EI in adolescents in transition throughout high school. Implications: Strengthening EI may contribute to adolescents’ feelings of self-worth, skills in coping, and competence within an ethnically diverse society. Nurses might plan interventions to strengthen EI throughout adolescence.

Nurses are educated to provide culturally competent care. Cultural competence begins with cultural awareness, a concept previously measured with the Cultural Awareness Scale (CAS). The purpose of this study was to reanalyze the CAS to determine construct validity and differences in cultural awareness among students of varying educational levels and experiences. The sample consisted of 150 nursing students (92% female, 33.6% racial minorities). Confirmatory factor analysis yielded three factors (CFI = 0.868, TLI = 0.854, RMSEA = 0.065, and SRMR = 0.086). Cronbach’s alpha ranged from 0.70 to 0.89. There were significant differences among educational levels, with lower division BSN students generally scoring higher than upper division and master’s of science in nursing students. Students who had taken courses on cultural diversity or global health generally outscored those who had not taken such courses. Findings support the validity of the CAS and its applicability to research studies of cultural awareness in nursing. [ J Nurs Educ. 2014;53(2):71–76.]

The purpose of this systemic literature review is to unveil a greater understanding of Physical Activity in Latinas. We used PubMed and PsycInfo databases to search for articles published between 1991 and August 2016, examining physical activity and its correlates exclusively in adult Latinas. Only 21 primary studies met the inclusion criteria. Although physical activity derives from body movements in various domains, the leisure domain led the focus of research interest. The use of self-reports, cross-sectional design, and the ecological framework predominated. Only one study included examining the occupational domain, albeit as disaggregate in studies with a general physical activity approach. Occupational physical activity showed negative associations with education and acculturation. Positive associations were found between leisure-time physical activity, education, acculturation, and perceived health status. Despite the limited evidence to reach overall conclusions, this review uncovered methodological challenges and opportunities to advance knowledge about physical activity in Latinas.

Although the major threats to health and life during adolescence are related to a few preventable health-risk behaviors (e.g., smoking, drinking alcohol, using illicit drugs), engaging in health-promoting behaviors can lead to a number of immediate and long-term positive health outcomes (Pender, Murdaugh, & Parsons 2010). Health-promoting behaviors such as physical activity and eating foods low in fat have been shown to protect adolescents from adverse health outcomes (Hayman & Reineke, 2003; Johnson, Li, Galati, Pedersen, Smyth, & Parcel, 2003) and contribute to a healthy lifestyle over time (Kelder et al., 2003). Engaging in a healthy lifestyle during adolescence may prevent cardiovascular disease and cancer later in life (Grunbaum, Lowry, & Kann, 2001). The influence of friends on adolescents’ unhealthy behaviors is well-established, as are the protective effects of parent connectedness against risky behaviors, but the influence of friends and parents on adolescents’ health-promoting behaviors is examined less frequently. In the present study, we focus on the influence of parents’ and peers’ health behaviors and social connectedness of caring adults and friends on health-promoting behaviors in adolescents, and we provide evidence that should facilitate the development of health-promoting behaviors through family-focused interventions. Although parents may provide verbal messages about the inherent dangers of engaging in risky health behaviors (Ford, Davenport, Meier, & McRee, 2011), their own actions often model behaviors that their children then imitate (Griesler & Kandel, 1998). Pender and colleagues’ (2010) conceptualization of health-promoting behavior posits that behavior is learned from observing and interacting with other people in one’s social environment. These nurse scientists (2010) proposed that a person is more likely to engage in health-promoting behaviors when significant people such as family members and peers model that behavior and provide social support to facilitate such behaviors. Parents, by virtue of their central position in the social environment of the developing adolescent, play an important role in modeling health-promoting or health-risking behaviors. Parental monitoring, which includes knowing where children are when not in school, and parental religious practices have been shown to protect young adolescents from dating violence (Howard, Qiu, & Boekeloo, 2003). Parenting style, which includes parents’ responsiveness to and demandingness of their children, has been shown to protect adolescents from engaging in health-risk behaviors (Stephenson, Quick, Atkinson, & Tschida, 2005). Peers also influence adolescents’ health behaviors (Dornelas et al., 2005; Wills, Gibbons, Gerrard, Murry, & Brody, 2003). For example, positive peer influences and social connectedness are related to adolescents’ positive health behaviors (Bruening et al., 2012). Less is understood, however, concerning the influence of parents’ own health behaviors and their parenting styles on their children’s health behaviors. Some have suggested that authoritative parenting styles (Milevsky, Schlechter, Netter, & Keehn, 2007) and engaging in organized religious activities (Haglund & Fehring, 2010; Manlove, Terry-Humen, Ikramullah, & Moore, 2006) may protect adolescents from engaging in health-risk behaviors. Protective factors within the family such as warmth, caring, and appropriate supervision have been cited as the most potent forms of protection, particularly within the Latino culture (Prado et al, 2007). How parenting style and parents’ monitoring and health-related behaviors influence their adolescent children’s participation in developing specific health-promoting behaviors therefore remains unclear. Few studies have examined parents as role models of health-promoting or self-care behaviors for their adolescent child’s health-related behaviors. The present study was undertaken (a) to determine the influence of parents’ self-care behaviors and parenting behavior on health-promoting behaviors of their adolescent children and (b) to determine the influence of selected parenting behaviors (i.e., parenting style, parental monitoring, and parents’ religious commitment) as well as adolescents’ perceptions of other influences (i.e., social connectedness, peers, and religious commitment) on the adolescents’ health-promoting behaviors.

Female homeless youths are vulnerable to risky sex and substance use behaviors, yet they have strengths known as psychological capital. A quasi-experimental pre-post research design with repeated measures was used to examine the feasibility and preliminary efficacy of a brief intervention to enhance psychological capital, reduce health-risk behaviors, and achieve short-term behavioral goals. Study participants were 80 ethnically diverse homeless women between the ages of 18 and 23 years. Intervention participants had significant improvements in psychological capital, hope, resilience, and self-efficacy to refuse alcohol, social connectedness, and substance use ( p < .05). There was a significant group by time interaction for safe sex self-efficacy; intervention participants had greater self-confidence in negotiating safer sex practices than comparison participants. At the follow-up post-test, 82% of intervention participants who remained in the study had met or exceeded their short-term goals. This brief, street-based intervention was feasible and showed preliminary efficacy.

PROBLEM: Little is known about what produces stress in preadolescents. METHODS: Secondary data analysis using hierarchical linear modeling was performed to determine how stressors and coping changed over time in 1,568 preadolescents (51% Hispanic) in 28 public schools. FINDINGS: Over time, participants experienced most stressors less intensely, but intensity varied by gender. Children in lower grades and girls found that coping strategies used were more effective compared with those in upper grades or boys. There were several interactions of grade level, sex, and ethnicity. CONCLUSION: Changes in stress and coping among preadolescents have implications for nurses concerned with mental health.

Purpose. The purpose of this research was to investigate older adolescents' perceptions of Do-It-Yourself Genetic Assessment (DIYGA) services online and factors that influence their intentions to utilize DIYGA services. Design and Methods. A convenience sample of 111 undergraduate students completed an online survey based on the Theory of Planned Behavior. Results. Most respondents (80.4%) had not heard of DIYGA services. Predictors of intentions to use DIYGA services included attitudes, subjective norms, and perceived risk of developing a genetic disorder. Practice Implications. Nurses are in a unique position to provide much-needed education and guidance to adolescents about genetic testing, particularly given mass media sources were the primary sources of information among these adolescents.

Purpose: We examined relationships among demographic and clinical characteristics, spiritual well-being, and psychosocial adjustment in Taiwanese patients with colorectal cancer and a colostomy. Design: A descriptive, cross-sectional, exploratory study design was used to answer research questions. Subjects and setting: Participants were recruited from the outpatient ambulatory clinic in the gastrointestinal surgical department at the medical center of National Taiwan University. Forty-five Taiwanese patients aged 42 to 83 years who were diagnosed with colorectal cancer and underwent colostomy surgery participated in the study. Methods: Participants completed a personal data questionnaire designed for this study, along with 2 validated instruments, the Spiritual Well-Being Scale and the Psychosocial Adjustment to Illness Scale-Self Report. Findings: Forty-five persons participated in the study; 69% reported a moderate level of spiritual well-being. Participants reported strong adjustment to extended family relationships, but poor adjustment in sexual relationships. Spiritual well-being was significantly associated with psychosocial adjustment (r = -0.52, P < .01), and 4 predictors (income change after surgery, self-rated disease severity, time since surgery, and spiritual well-being) accounted for 53% of the variance in psychosocial adjustment. Conclusions: Spiritual well-being plays an important role for Taiwanese patients when faced with psychosocial adjustment related to life with colorectal cancer and a colostomy.

The major morbidities and mortalities of adolescents are related to preventable risky behaviors, but how, when, and in whom these behaviors develop in early adolescence is unknown. The purpose of this study was to determine which set of risk factors and protective resources of school-age children were best predictors of health-risk behaviors in early adolescence. A longitudinal, cohort sequential design was used with a diverse sample of 1,934 children in grades 4 through 8. Parents provided demographic and neighborhood data for children through a mailed survey. Children completed valid scales annually at schools, using audio-computer-assisted self-interviewing (A-CASI) technology. Significant gender and racial/ethnic differences were found in carrying a weapon and using alcohol. Higher perceived levels of stress increased the risk for alcohol use as did riding in a car with a driver who was drinking. Health behaviors exhibited while in 4th through 6th grades protected early adolescents from alcohol use and riding in a car with a driver who was drinking. A parent's education and perceived safety in neighborhood protected against carrying a weapon and smoking. Many findings are similar to those of national samples, but others show positive differences in this localized sample, over 50% of whom were Latino. Protective resources suggest numerous nursing interventions to promote healthy adolescent development.

Purpose. With current emphasis on evidence-based practice, nurses are searching for answers to questions generated at the bedside. One method to identify and evaluate the existing evidence is to conduct or read a systematic review of the literature. The purpose of this paper is to describe the process of conducting a systematic review of literature. Conclusion. Defining attributes, rationale for, and steps in conducting systematic reviews are presented. Examples from published reviews on pediatric nursing are included. Practice Implications. Pediatric nurses may consult professionally prepared systematic reviews, such as The Cochrane Collection, or conduct their own reviews with the help of electronic search engines.

Aims and objectives. To synthesise the body of literature on workplace violence in the emergency department and to identify characteristics of intervention studies that are the basis for guiding best practice modelling in the clinical setting. The research question addressed was what are the characteristics and findings of studies since 2004 on workplace violence in the emergency department? Background. Emergency departments are prone to increased incidents of workplace violence. Workplace violence in the health care setting has become a hot topic of policy, political debate and research in recent years. Despite the research that has been carried out in this area, little consensus exists as to what are the best practices for mitigating violence in this setting. Design. Systematic literature review. Methods. Search using four online databases, including MEDLINE, CINAHL, PsycINFO and the Dissertations and Theses Full Text Database. Results. Most research focused on the incidence rates of workplace violence in the emergency department and effects on staff. There was a significant lack of intervention studies to provide a framework for guiding evidence-based practice. Themes of under-reporting violence, barriers and attitudes towards reporting, description and characterisation of incidents of violence, predisposing factors and the concept of safety or lack of fear were all major content areas addressed in the literature. Conclusions. Incidence of workplace violence in the emergency department has been well documented in numerous published studies. Emergency department workers are exposed to significant rates of physical and verbal abuse. Under-reporting of workplace violence in the emergency department is common and contributes to the difficulty in accurately tracking violence. Relevance to clinical practice. Future research must move beyond descriptive studies to include more advanced research methods. Few practice-guiding implications can be gained from this body of research because of the lack of intervention studies.

Genetic testing can help individuals and families by giving them a sense of control over their futures; however, results of some types of testing cause individuals and their families great distress and anxiety. The purpose of this paper is to report findings from a systematic review of literature about perceived benefits and harms associated with genetic testing. A second purpose was to determine if perceived benefits and harms varied by age and gender. We reviewed a sample of 30 articles published between 1997 and 2009. Most of the articles were other literature reviews. We summarized the benefits and harms associated with each type of genetic testing and made recommendations for future study. As technologies increase, genetic testing will expand and psychiatric mental health nurses must be prepared to meet the challenges of psychosocial disorders that may develop in response to genetic testing.

The purpose of this pilot study was to develop a mentoring program for the promotion of sexual health among Korean adolescents and to explore the effects of the program. A nonequivalent control group pre-test–post-test design was used. The mentoring intervention was conducted by eight nursing students who participated in the program as mentors using various methods such as formal group sessions and informal individual contacts. At the 12-week post-intervention, the interaction between time and group was statistically significant on both sexual knowledge and sexual attitude of the 17 adolescent mentees. The mentoring program demonstrated potential as a developmentally appropriate intervention for the sexual health promotion of adolescents and promises to enable nursing students to gain confidence in their professional capability.

Advances in genomic science create both opportunities and challenges for future generations. Both adolescents and adults may benefit or be harmed by decisions they make in response to this new science. Using a qualitative descriptive design, the authors interviewed 22 adolescents (11 who were aged 14-17 years and 11 who were 18-21 years) and 11 parents to determine levels of knowledge and approaches to decision making. It was found that younger adolescents and their parents have very limited knowledge about genetics and genetic testing. Older adolescents have more complete information and consider a broader range of points in making decisions about hypothetical situations involving genetic testing. Adolescents and parents need much more information to enhance their ability to make decisions about using genetic services. These findings have implications for developing interventions and public health policy highlighted by the need for improved education about the benefits and harms of genetic testing.

Health behaviors of school-aged children are the precursors of adolescents' health-risk behaviors. The study reported here is the first wave of a cohort-sequential longitudinal study of health-risk behaviors in youth. Using a youth resilience framework, researchers collected data from 1,934 youth in Grades 4-6. Statistically significant differences in health behaviors were found for gender, ethnicity, and grade level, which accounted for only 2% of the variance. Risk and protective factors accounted for an additional 18% of variance in health behaviors. With the federal mandate for schools to establish wellness policies, school nurses are ideally situated to influence school environments to support children's healthy behaviors.

This study explored gender differences, sexual self-concept and life on the street among homeless adolescents who self-reported a history of sexual abuse. Individual interviews were conducted with 13 adolescents (six males and seven females) aged 18–20 years. There were salient themes shared by both males and females (vulnerability, sexual harassment, survival sex), and one theme specific to bisexual adolescents. Both males and females described aspects of their vulnerability related to being male or female. More than half the participants also described incidents of sexual harassment. In addition, both males and females stated that females needed the protection of males. Only one theme specific to youth with a bisexual orientation emerged related to the advantages of being bisexual. The findings indicate that sexual maturation takes place within the context of social and cognitive changes that can profoundly influence an individual's ability to develop a healthy sexual self-concept, including sexual awar...