Using the Points of Distribution Site Model for Timely and Safe Administration of COVID-19 Vaccinations During the Pandemic.

The Georgia Department of Public Health-East Central District and its local partners implemented an open, drive-through point of distribution site to administer the COVID-19 vaccine to eligible populations. The site was in Augusta, Georgia, from mid-December 2020 through mid-May 2021. The target population for this intervention was individuals eligible for the COVID-19 vaccine to prevent and slow transmission of severe acute respiratory syndrome coronavirus 2 infection. The point of distribution site successfully provided 42 342 vaccines. (Am J Public Health. 2022;112(S3):S279-S283. https://doi.org/10.2105/AJPH.2022.306820).

Examining the Impact of a Nursing Course Redesign on Student Outcomes, Faculty Workload, and Costs.

ABSTRACT: This study examined the impact of a nursing course redesign from traditional face-to-face to a hybrid format on student outcomes, workload allocation, and associated costs. In this quasi-experimental study, baccalaureate students received either traditional (n = 47) or hybrid delivery (n = 46); each group had equal degree-type representation. Average exam scores were analyzed using an independent t-test, with no significant differences found between groups. Faculty workload decreased by one third, and there was a 16.6 percent reduction in overall costs to implement the course. Course redesign can be effective for reducing faculty workload and costs while achieving course outcomes.

Integrating Stakeholder Engagement With Claims-Based Research on Health Insurance Design and Bipolar Disorder.

Researchers increasingly recognize that stakeholder involvement enhances research relevance and validity. However, reports of patient engagement in research that relies on administrative records data are rare. The authors' collaborative project combined quantitative and qualitative studies of costs and access to care among U.S. adults with employer-sponsored insurance. The authors analyzed insurance claims to estimate the impacts on enrollee costs and utilization after patients with bipolar disorder were switched from traditional coverage to high-deductible health plans. In parallel, in-depth interviews explored people's experiences accessing treatment for bipolar disorder. Academic investigators on the research team partnered with the Depression and Bipolar Support Alliance (DBSA), a national advocacy organization for people with mood disorders. Detailed personal stories from DBSA-recruited volunteers informed and complemented the claims analyses. Several DBSA audience forums and a stakeholder advisor panel contributed regular feedback on study issues. These multiple engagement modes drew inputs of varying intensity from diverse community segments. Efforts to include new voices must acknowledge individuals' distinct interests and barriers to research participation. Strong engagement leadership roles ensure productive communication between researchers and stakeholders. The involvement of people with direct experience of care is especially necessary in research that uses secondary data. Longitudinal, adaptable partnerships enable colearning and higher-quality research that captures the manifold dimensions of patient experiences.

Construction of Femoral Vessel Nomograms for Planning Cardiac Interventional Procedures in Children 0-4 Years Old.

The objectives of this study were to construct femoral artery (FA) and femoral vein (FV) nomograms in children aged 0-4 years and to construct probability curves for the occurrence of arterial access complications based on the size of the FA. The FV and FA are commonly accessed during cardiac catheterizations in children with congenital heart diseases (CHD). However, nomograms for vessel dimensions based on child's age or size are not available. This knowledge may be helpful for interventional planning. A prospective study was performed on 400 children (age 0-4 years) with CHD undergoing cardiac catheterizations over a 3-year period. Ultrasound evaluation of the right and left FA and FV was performed under anesthesia prior to vascular access. Regression modeling was applied to derive nomograms based on quantile polynomial regression, which yielded good fit to the data judged by R-squared. GAMLSS transformation method was used to formulate smoothed percentiles. A separate prospective evaluation of FA to determine the size below which loss of pulse (LOP) are likely to occur was performed. Nomograms for FA and FV diameter and cross-sectional area against age and body surface area and probability curves for FA LOP were constructed. It is now possible to examine ultrasound-based normal sizes of femoral vein and artery in children 0-4 years of age. Femoral vessel nomograms and LOP probability curves may help with interventional planning. Future studies with larger sample size, including children of other ages may be useful.

Utility of the Medtronic microvascular plug™ as a transcatheter implantable and explantable pulmonary artery flow restrictor in a swine model.

BACKGROUND: A surgical pulmonary artery band (PAB) is used to control excessive pulmonary blood flow for certain congenital heart diseases. Previous attempts have been made to develop a transcatheter, implantable pulmonary flow restrictor (PFR) without great success. We modified a microvascular plug (MVP) to be used as a PFR. The objectives of this study were to demonstrate feasibility of transcatheter implantation and retrieval of the modified MVP as a PFR, and compare PA growth while using the PFR versus PAB. METHODS AND RESULTS: The PFR was implanted in eight newborn piglets in bilateral branch pulmonary arteries (PAs). Immediately post-PFR implantation, the right ventricular systolic pressure increased from a median of 20-51 mmHg. Transcatheter retrieval of PFR was 100% successful at 3, 6, and 9 weeks and 50% at 12-weeks post-implant. A left PAB was placed via thoracotomy in four other newborn piglets. Debanding was performed 6-weeks later via balloon angioplasty. On follow-up, the proximal left PA diameters in the PFR and the PAB groups were similar (median 8 vs. 7.1 mm; p = 0.11); albeit the surgical band sites required repeat balloon angioplasty secondary to recurrent stenosis. By histopathology, there was grade II vessel injury in two pigs immediately post-retrieval of PFR that healed by 12 weeks. CONCLUSIONS: Transcatheter implantation and retrieval of the MVP as a PFR is feasible. PA growth is comparable to surgical PAB, which is likely to require reinterventions. The use of the MVP as a PFR in humans has to be trialed before recommending its routine use.

Can transcatheter PDA closure be performed in neonates ≤1000 grams? The Memphis experience.

OBJECTIVE: Advancements in transcatheter technology have now made it possible to safely close patent ductus arteriosus (PDA) in extremely low birth weight (ELBW) infants. The objective of this article is to describe our technique for transcatheter PDA closure (TCPC) in ELBW infants. DESIGN: The techniques employed are very specific to this population and are drastically different when compared to the procedure performed in patients weighing >5 kg. SETTING: A multidisciplinary team approach should be taken to evaluate and manage ELBW infants in order to achieve success. It is important that specific techniques with venous-only approach outlined in this article be followed to achieve optimal results with low risk of complications. PATIENTS: To date, in Memphis, 55 ELBW infants have had successful TCPC at a weight of ≤1000 g with minimal procedure-related complications. INTERVENTIONS: It is important that specific techniques with venous-only approach outlined in this article be followed to achieve optimal results with low risk of complications. OUTCOME MEASURES: This procedure entails a steep learning curve and should be limited to specialized centers with expertise in these thanscatheter procedures. RESULTS: There has been 100% procedural success of performing TCPC in children ≤1000 g. There have been only two procedure-related complications which happened to the first two patients, ≤1000 g, that we performed TCPC on. CONCLUSIONS: It is feasible and probably safe to perform TCPC in children ≤1000 g. The techniques described in this article represent our institutional experience and have helped us improve clinical outcomes in ELBW infants.

Live broadcast of transcatheter PDA closure in a 700 grams ELBW infant during the International PDA Symposium.

OBJECTIVE: The objective of this article is to describe a live case transmission of transcatheter closure of a patent ductus arteriosus (PDA) in an extremely low birth weight (ELBW) infant during the first International PDA Symposium conducted in Memphis, Tennessee. SETTING: A multidisciplinary team approach including audiovisual specialists, information technology specialists, physicians, nurses, and other health care specialists was required to perform the transcatheter PDA closure (TCPC) in an ELBW infant at LeBonheur Children's Hospital and the procedure was broadcast live to the attendees at the International PDA Symposium allowing for a two-way audiovisual discussion during the procedure. PATIENT: The patient was a 14 days old 24-week premature ELBW infant, who weighed 700 g at the time of the procedure. The patient was requiring mechanical ventilation secondary to pulmonary hemorrhage. The PDA measured 4 mm in diameter and 12 mm in length. INTERVENTIONS: TCPC was performed safely without any procedural complications using a specialized minimally invasive technique. OUTCOME MEASURES: The patient was weaned off the ventilator in < 7 days after the procedure. The child was discharged 9 weeks after the procedure (35 weeks' corrected gestation) weighing 2.2 kg, on full oral feeds and no supplemental oxygen. RESULTS: The successful TCPC allowed for this child to have an uneventful hospital course. The case also highlights the technical nuances involved in setting up the live transmission. CONCLUSIONS: This case demonstrated to the audience in the International PDA Symposium the feasibility and safety of performing TCPC in an ELBW infant. Live cases are useful in exhibiting the nuances involved in any new technique and allows for best learning experience.

Role of Transcatheter patent ductus arteriosus closure in extremely low birth weight infants.

BACKGROUND: Patent ductus arteriosus (PDA) is common in extremely low birth weight (ELBW) infants. The objectives of this study were to describe our early clinical experience of transcatheter PDA closure (TCPC) in ELBW infants, compare outcomes with surgical ligation of PDA (SLP), and identify risk factors for prolonged respiratory support. METHODS: A retrospective review was performed comparing infants born <27 weeks, weighing <1 kg at birth and < 2 kg during TCPC with 2:1 propensity-score matched group of infants that underwent SLP. Change in respiratory severity scores (RSS) immediately post-procedure and the time taken for return to pre-procedure RSS for TCPC versus SLP was compared. Factors contributing to prolonged elevation of RSS were identified. RESULTS: Eighty ELBW infants (median procedure weight: 1060 [range 640-2000] grams) that underwent successful TCPC were compared with 40 infants that underwent SLP (procedure weight 650-1760 g). There was greater increase in RSS following SLP compared to TCPC (76% vs. 18%; P < 0.01). It took longer for RSS to return to pre-procedural scores post-SLP compared to post-TCPC (28 vs. 8.4 hr; P < 0.01). Elevated pulmonary artery pressure (PAP) and TCPC at >8 weeks of age were associated with prolonged (>30-days) elevation of RSS ≥ 1 (OR = 5.4, 95%CI: 2.2-9.4, P < 0.01 and OR = 2.86, 95%CI: 1.5-4.2, P = 0.05 respectively). Overall complication rate for TCPC was 3.7%. CONCLUSIONS: TCPC is feasible in infants as small as 640-2000 g and can be performed safely in the majority. TCPC may offer faster weaning of respiratory support compared to SLP when performed earlier in life, and before the onset of elevated PAP.

Conceptual Model for Predicting Academic Success in Prelicensure Nursing Programs Through Expanded Cognitive Aptitude Assessment.

BACKGROUND: Attrition from prelicensure nursing programs is a serious issue with implications for students, nursing programs, and the nursing workforce. Academic failure due to insufficient cognitive aptitude often contributes to this problematic attrition rate. Thus, cognitive aptitude could be included in admission criteria, as a predictor of academic success and a strategy to minimize attrition. PROBLEM: Currently, admissions practices are often incomplete and lack standardization for measuring cognitive aptitude. APPROACH: The Nursing Cognitive Aptitude Model (NCAM) presented in this article is an innovative conceptual model to guide educators in expanding current admissions processes. CONCLUSION: The NCAM model depicts the cognitive domains involved in student academic success including current scholastic knowledge, previous academic performance, and critical-thinking ability. Together, these three domains predict student academic success and are a useful reference for the admissions process.

Industrially-Scalable Microencapsulation of Plant Beneficial Bacteria in Dry Cross-Linked Alginate Matrix.

Microencapsulation of plant-beneficial bacteria, such as pink pigmented facultative methylotrophs (PPFM), may greatly extend the shelf life of these Gram-negative microorganisms and facilitate their application to crops for sustainable agriculture. A species of PPFM designated Methylobacterium radiotolerans was microencapsulated in cross-linked alginate microcapsules (CLAMs) prepared by an innovative and industrially scalable process that achieves polymer cross-linking during spray-drying. PPFM survived the spray-drying microencapsulation process with no significant loss in viable population, and the initial population of PPFM in CLAMs exceeded 1010 CFU/g powder. The PPFM population in CLAMs gradually declined by 4 to 5 log CFU/g over one year of storage. The extent of alginate cross-linking, modulated by adjusting the calcium phosphate content in the spray-dryer feed, did not influence cell viability after spray-drying, viability over storage, or dry particle size. However, particle size measurements and light microscopy of aqueous CLAMs suggest that enhanced crosslinking may limit the release of encapsulated bacteria. This work demonstrates an industrially scalable method for producing alginate-based inoculants that may be suitable for on-seed or foliar spray applications.

Cx43 overexpression in osteocytes prevents osteocyte apoptosis and preserves cortical bone quality in aging mice.

Young, skeletally mature mice lacking Cx43 in osteocytes exhibit increased osteocyte apoptosis and decreased bone strength, resembling the phenotype of old mice. Further, the expression of Cx43 in bone decreases with age, suggesting a contribution of reduced Cx43 levels to the age-related changes in the skeleton. We report herein that Cx43 overexpression in osteocytes achieved by using the DMP1-8kb promoter (Cx43OT mice) attenuates the skeletal cortical, but not trabecular bone phenotype of aged, 14-month-old mice. The percentage of Cx43-expressing osteocytes was higher in Cx43OT mice, whereas the percentage of Cx43 positive osteoblasts remained similar to wild type (WT) littermate control mice. The percentage of apoptotic osteocytes and osteoblasts was increased in aged WT mice compared to skeletally mature, 6-month-old WT mice, and the percentage of apoptotic osteocytes, but not osteoblasts, was decreased in age-matched Cx43OT mice. Aged WT mice exhibited decreased bone formation and increased bone resorption as quantified by histomorphometric analysis and circulating markers, compared to skeletally mature mice. Further, aged WT mice exhibited the expected decrease in bone biomechanical structural and material properties compared to young mice. Cx43 overexpression prevented the increase in osteoclasts and decrease in bone formation on the endocortical surfaces, and the changes in circulating markers in the aged mice. Moreover, the ability of bone to resist damage was preserved in aged Cx43OT mice both at the structural and material level. All together, these findings suggest that increased Cx43 expression in osteocytes ameliorates age-induced cortical bone changes by preserving osteocyte viability and maintaining bone formation, leading to improved bone strength.

Rolling-refresher simulation improves performance and retention of paediatric intensive care unit nurse code cart management.

INTRODUCTION: Paediatric Intensive Care Unit Nurses (PICU RNs) manage the code cart during paediatric emergencies at the Children's Hospital at Dartmouth-Hitchcock. These are low -frequency, high-stakes events. METHODS: An uncontrolled intervention study with 6-month follow-up. A collaboration of physician and nursing experts developed a rolling-refresher training programme consisting of five simulated scenarios, including 22 code cart skills, to establish nursing code cart competency. The cohort of PICU RNs underwent a competency assessment in training 1. To achieve competence, the participating RN received immediate feedback and instruction and repeated each task until mastery during training 1. The competencies were repeated 6 months later, designated training 2. RESULTS: Thirty-two RNs participated in training 1. Sixteen RNs (50%) completed the second training. Our rolling-refresher training programme resulted in a 43% reduction in the odds of first attempt failures between training 1 and training 2 (p=0.01). Multivariate linear regression evaluating the difference in first attempt failure between training 1 and training 2 revealed that the following covariates were not significantly associated with this improvement: interval Paediatric Advanced Life Support training, interval use of the code cart or defibrillator (either real or simulated) and time between training sessions. Univariate analysis between the two trainings revealed a statistically significant reduction in first attempt failures for: preparing an epinephrine infusion (72% vs 41%, p=0.04) and providing bag-mask ventilation (28% vs 0%, p=0.02). CONCLUSIONS: Our rolling-refresher training programme demonstrated significant improvement in performance for low-frequency, high-risk skills required to manage a paediatric code cart with retention after initial training.

Acute and long-term effects of endovascular debanding of pulmonary arteries in a swine model.

OBJECTIVES: The primary objective of this study was to demonstrate that pulmonary artery (PA) debanding via cardiac catheterization using balloon angioplasty is feasible and safe in swine. The secondary objectives were to determine the acute and long-term effects of this therapy. DESIGN: This is a chronic survival experimental study in newborn swine. BACKGROUND: PA bands are used in infants for transient palliation of congenital heart defects with excessive pulmonary blood flow. Although rare, if these defects should close spontaneously or become hemodynamically insignificant, a sternotomy and occasionally cardiopulmonary bypass may still be required for band removal. Alternatively, debanding could be accomplished through less invasive methods. INTERVENTIONS: The main pulmonary artery was banded in three piglets, and the left pulmonary artery in five piglets via mini-thoracotomy at a mean weight of 2.5 kg. Following a threefold increase in weight, the piglets underwent PA debanding via balloon angioplasty. Four piglets were sacrificed to evaluate the acute effects. The remainder were followed to evaluate long-term effects. Histopathology was performed on all piglets. OUTCOME MEASURES: Reintervention rates. Histopathologic consequences of high pressure balloon angioplasty used for PA debanding acutely and after reinterventions. RESULTS: Debanding was performed at a mean weight of 8.1 ± 2.23 kg. The median preintervention gradient across the band was 18 mm Hg. Debanding was successful in all piglets. The median postintervention gradient was 3.5 mm Hg. All piglets in the long-term model required re-interventions for recurrent stenosis at mean weights of 26 ± 1.6 and 61 ± 3.2 kg. Histopathology demonstrated vessel wall injury in only one piglet. CONCLUSIONS: Endovascular PA debanding can be safely achieved in a swine model. Angioplasty following debanding may be necessary for recurrent stenosis. This catheter-based therapy may provide a less-invasive alternative to surgery.

Influence of Clothing on Thermoregulation and Comfort During Exercise in the Heat.

Davis, JK, Laurent, CM, Allen, KE, Zhang, Y, Stolworthy, NI, Welch, TR, and Nevett, ME. Influence of clothing on thermoregulation and comfort during exercise in the heat. J Strength Cond Res 31(12): 3435-3443, 2017-Sport textiles of synthetic fiber have been proposed to have superior properties for keeping wearers cooler, drier, and more comfortable compared with natural fibers. The impact of various fiber content and fabric construction on thermoregulation and perceptual responses are not well understood. Eight male collegiate athletes performed 3 counterbalanced trials of 45-minute treadmill run at 60% of maximal oxygen uptake in an environmental chamber (32° C). Three different fibers, consisting of 100% cotton, a blend of natural fibers (50/50% cotton/soybean), and a synthetic fiber (100% polyester) with mesh loops to facilitate ventilation through the clothing, were tested. Heat strain indices, microenvironment temperature, ratings of perceived exertion (RPE), and clothing comfort were measured. Session RPE (S-RPE) and session thermal sensation (S-TS) were recorded 20 minutes after each trial. There was no effect of clothing on rectal, skin, and body temperatures, heart rate, RPE, or comfort measures (p ≥ 0.05). A significant effect was observed for synthetic fiber compared with cotton on S-RPE (p = 0.03), S-TS (p = 0.04), and the microenvironment temperature at the chest (p = 0.02). No significant difference was shown for any other fibers on S-RPE, S-TS, or other microenvironment areas (p ≥ 0.05). These results show that clothing fiber content and fabric construction had no effect on thermoregulation, RPE, or clothing comfort during moderate-intensity exercise in the heat; whereas synthetic fabric construction indeed effectively reduced regional microenvironment temperature and attenuated global exertion and TS, which may have important implications for exercise tolerance in the heat.

The Risks and Benefits of Conducting Sensitive Research to Understand Parental Experiences of Caring for Infants With Hypoxic-Ischemic Encephalopathy.

AIM: The aim of this report is to describe the parental experience of the emotional and physical risks and participant burden of participation in sensitive research about caring for an infant with hypoxic-ischemic encephalopathy. BACKGROUND: Protecting the ethical rights of participants in research is a main focus of investigators. Evaluating the effect of current methods employed to protect participants in sensitive research is necessary to determine if the participants' ethical rights are protected. Little research has addressed the parental perspective of participating in sensitive research. DESIGN: The design of this study is a qualitative, descriptive methodology with structured interviews with parents. METHODS: Participants were asked to describe their experience of participating in sensitive research. The qualitative data collected were analyzed using content analysis. Interviews were conducted between July 2010 and February 2012. RESULTS: Thirteen parents of infants with hypoxic-ischemic encephalopathy were interviewed. Parents did not report harm or participant burden. Most of these parents found continued participation to be beneficial because they could express intense emotions in a nonjudgmental environment and also reflect on the milestones their child has reached since the traumatic birth experience. CONCLUSIONS: This study provides additional evidence to researchers regarding the risks and benefits to participants in sensitive research studies. Individuals are willing to participate in sensitive research, even during stressful times in their lives. The interviews allow participants an outlet to discuss thoughts and feelings and to reflect on past events and gain perspective. Participants do not report experiencing harm when participating in interviews about sensitive research.

Ethnic identity trajectories among Mexican-origin girls during early and middle adolescence: Predicting future psychosocial adjustment.

We examined trajectories of ethnic identity exploration, resolution, and affirmation and their associations with depressive symptoms and self-esteem 3.5 years later among early and middle adolescent Mexican-origin girls (N = 338). Findings indicated that exploration, resolution, and affirmation increased over time for both cohorts. Among early adolescents, growth in exploration was associated with more depressive symptoms during middle adolescence, whereas higher initial levels and greater rates of change of affirmation predicted fewer subsequent depressive symptoms. Among middle adolescents, higher baseline levels of exploration and affirmation predicted fewer depressive symptoms in late adolescence. Higher initial levels and greater change in affirmation predicted higher self-esteem among both cohorts. Findings highlight the developmental and multifaceted quality of ethnic identity and that associations between ethnic identity and adjustment may vary by adolescent developmental stage. (PsycINFO Database Record

Pathophysiology and Treatment of Severe Traumatic Brain Injuries in Children.

Traumatic brain injuries (TBIs) in children are a major cause of morbidity and mortality worldwide. Severe TBIs account for 15,000 admissions annually and a mortality rate of 24% in children in the United States. The purpose of this article is to explore pathophysiologic events, examine monitoring techniques, and explain current treatment modalities and nursing care related to caring for children with severe TBI. The primary injury of a TBI is because of direct trauma from an external force, a penetrating object, blast waves, or a jolt to the head. Secondary injury occurs because of alterations in cerebral blood flow, and the development of cerebral edema leads to necrotic and apoptotic cellular death after TBI. Monitoring focuses on intracranial pressure, cerebral oxygenation, cerebral edema, and cerebrovascular injuries. If abnormalities are identified, treatments are available to manage the negative effects caused to the cerebral tissue. The mainstay treatments are hyperosmolar therapy; temperature control; cerebrospinal fluid drainage; barbiturate therapy; decompressive craniectomy; analgesia, sedation, and neuromuscular blockade; and antiseizure prophylaxis.

Design of a Medical Triage Evidence-Based Clinical Management Protocol and Implementation of Medical Triage On-Line Training for Use by Mission of Mercy Volunteers.

Evidence-based protocols in safety net settings can help standardize care practices, increase organizational workflow, and enhance quality outcomes for those receiving services. The purpose of this quality improvement project is two-fold: to design an evidence-based medical triage clinical management protocol, and, to influence adherence to that protocol by safety net medical triage volunteers through an on-line volunteer orientation. Leadership skills were required to help translate evidence-based practice recommendations into useful tools to assist in directing practice. Project outcomes included successful multidisciplinary practice change, significantly improved volunteer knowledge surrounding medical triage protocol parameters, increased organizational workflow, and enhanced quality client outcomes.

Is Prenatal Lead Exposure a Concern in Infancy? What Is the Evidence?

BACKGROUND: Exposure to unhealthy and unsafe environments cause 1 in 4 deaths in childhood each year. Early exposure to lead beginning prenatally and continuing throughout childhood is one of the mechanisms associated with unhealthy and unsafe environments, particularly in industrial countries and urban communities. Lead is a known heavy metal that crosses the placenta and blood-brain barrier depositing in fetal tissues. PURPOSE: The purpose of this integrative review was to determine which maternal-fetal dyads were at high risk for elevated umbilical cord lead (Pb) levels and to examine the consequences associated with elevated umbilical cord Pb levels. SEARCH STRATEGY: PubMed was searched to obtain English language publications from 2005 to March 2015 for studies examining the effects of prenatal lead exposure on infant outcomes using key terms "lead" combined with "infant." A total of 17 articles were retained for analysis. FINDINGS: Infants with elevated umbilical cord blood lead levels were associated with maternal demographic factors and country of origin. Maternal-specific exposure to lead products prior to or during pregnancy was associated with elevated umbilical cord blood lead levels. The consequences of prenatal lead exposure to the infant at birth anthropometrically were mixed. The evidence on neurological consequences of prenatal exposure to lead appears to reflect changes in cognitive impairment; however, it needs further study. IMPLICATIONS FOR PRACTICE: The major recommendation is primary prevention of lead exposure across the life span. Implementation of policies that reduce the availability of leaded products to reduce leaded products, especially ones aimed at children and women of childbearing age. IMPLICATIONS FOR RESEARCH: Research needs to be focused in 2 directions: (1) prevention of lead exposure during pregnancy and (2) prevention of lead leaching from bones for all women of childbearing age.

Pathways from Racial Discrimination to Multiple Sexual Partners Among Male African American Adolescents.

African American male adolescents' involvement with multiple sexual partners has important implications for public health as well as for their development of ideas regarding masculinity and sexuality. The purpose of this study was to test hypotheses regarding the pathways through which racial discrimination affects African American adolescents' involvement with multiple sexual partners. We hypothesized that racial discrimination would engender psychological distress, which would promote attitudes and peer affiliations conducive to multiple sexual partnerships. The study also examined the protective influence of parenting practices in buffering the influence of contextual stressors. Participants were 221 African American male youth who provided data at ages 16 and 18; their parents provided data on family socioeconomic disadvantages. Of these young men, 18.5% reported having 3 or more sexual partners during the past 3 months. Structural equation models indicated that racial discrimination contributed to sexual activity with multiple partners by inducing psychological distress, which in turn affected attitudes and peer affiliations conducive to multiple partners. The experience of protective parenting, which included racial socialization, closeness and harmony in parent-child relationships, and parental monitoring, buffered the influence of racial discrimination on psychological distress. These findings suggest targets for prevention programming and underscore the importance of efforts to reduce young men's experience with racial discrimination.