Exploring Cultural Factors of Human Papillomavirus Vaccination Acceptance in African Americans: An Integrative Review.

INTRODUCTION: Human papillomavirus (HPV) vaccine can prevent HPV-related cancers. However, African Americans (AA) have a 30% higher incidence of HPV-related cervical cancer than Whites. The purpose of this integrative review is to explore cultural factors and beliefs impacting HPV vaccine decisions in AA adults. METHODOLOGY: The Whittemore & Knafl model guided this review. Databases searched were PubMed, CINAHL, and Embase. Key terms included "human papillomavirus," "vaccine," "cultural values," "African American," and "adult." Inclusion criteria were AAs aged 18 years and over living in the United States. RESULTS: A total of 634 articles were identified, and 20 studies published from 2010 to 2020 were used. Common factors influencing HPV vaccine decisions included religion, knowledge, physician recommendation, social network, attitudes, mistrust, benefits, and safety. DISCUSSION: Limitations included omission of articles lacking AA representation, limited databases searched, and one-author-evaluated studies. Future studies to discover additional cultural factors influencing HPV vaccine acceptance are critical.

Client-Centered Breastfeeding-Promotion Strategies: Q Methodology.

Fewer Korean women are choosing the 6 months of exclusive breastfeeding that are recommended for obtaining its maximal benefits despite an increasing effort to promote breastfeeding. Successful breastfeeding education and counseling need to be segmentally designed on the basis of client characteristics. This study explored the perceptions of breastfeeding in pregnant and 6 month postpartum Korean women using the Q methodology, a useful research approach to examine personal perceptions, feelings, and values about a concept or phenomenon of interest and identify typologies of perspectives. The Q sample consisted of 38 statements representing the universe of viewpoints on breastfeeding. The P sample (N = 49) included women who shared their perceptions of breastfeeding and filled each grid with a statement in the Q sorting table. Data were analyzed using the PC-QUANL program. Varimax (orthogonal) rotation revealed four factors that explained 53.0% of variance: maternal privilege (Factor 1), option based on emotion (Factor 2), option if efficient (Factor 3), and option if I have sufficient problem-solving skills (Factor 4). Korean women have changed their attitudes toward breastfeeding, with all participants viewing breastfeeding as optional. Breastfeeding-promotion campaigns and education need to consider societal norms and changes in women's beliefs and perceptions.

Preconception Care to Reduce the Risks of Overweight and Obesity in Women of Reproductive Age: An Integrative Review.

Despite adverse pregnancy outcomes for women with overweight or obesity, preconception guidelines for achieving optimal wellness for women contemplating pregnancy regarding the risks of overweight or obesity are varied based upon national affiliation. The aim of this study was to synthesize the best evidence related to preconception counseling and care focused on overweight or obesity provided to women of reproductive age. An integrative review of original studies was conducted. PubMed, Cumulative Index in Nursing and Allied Health Literature, Ovid, Scopus, Web of Science, and Embase were included. Full-text, data-based articles were searched from 2009 to 2018, with reviews and synthesis completed in 2019 and 2020. Of 8703 initial articles, 31 articles remained in the review. Quality assessment and level of evidence were evaluated based upon criteria from the Joanna Briggs Institute and the Johns Hopkins Nursing Evidence-Based Practice Quality Guide. The level of evidence for the majority of studies was non-experimental but they were of good quality with appropriate methods, samples and relevant results. Limited attention and interest in preconception counseling regarding risks of overweight or obesity by health care professionals were noted, which may contribute to women's unawareness of these risks on preconception health.

Gestational Weight Gain and Adverse Birth Outcomes in Twin Pregnancies.

OBJECTIVE: To evaluate the association between gestational weight gain in twin pregnancies and small-for-gestational-age (SGA) and large-for-gestational-age (LGA) birth, preterm birth before 32 weeks of gestation, cesarean delivery, and infant death within each prepregnancy body mass index (BMI) category. METHODS: Data in this population-based study came from Pennsylvania-linked infant birth and death records (2003-2013). We studied 54,836 twins born alive before 39 weeks of gestation. Total pregnancy weight gain (kg) was converted to gestational age-standardized z scores. Multivariable modified Poisson regression models stratified by prepregnancy BMI were used to estimate associations between z scores and outcomes. A probabilistic bias analysis, informed by an internal validation study, evaluated the effect of BMI and weight gain misclassification. RESULTS: Gestational weight gain z score was negatively associated with SGA and positively associated with LGA and cesarean delivery in all BMI groups. The relation between weight gain and preterm birth was U-shaped in nonobese women. An increased risk of infant death was observed for very low weight gain among normal-weight women and for high weight gain among women without obesity. Most excess risks of these outcomes were observed at weight gains at 37 weeks of gestation that are equivalent to less than 14 kg or more than 27 kg in underweight or normal-weight women, less than 11 kg or more than 28 kg in overweight women, and less than 6.4 kg or more than 26 kg in women with obesity. The bias analysis supported the validity of the conventional analysis. CONCLUSION: Very low or very high weight gains were associated with the adverse outcomes we studied. If the associations we observed are even partially reflective of causality, targeted modification of pregnancy weight gain in women carrying twins might improve pregnancy outcomes.

Exploring the Experiences, Challenges, and Approaches of Parish Nurses in Their Community Practice.

PURPOSE: To explore the personal experiences, challenges, and practices of parish nurses in their communities. METHOD/DESIGN: The overall study used a mixed methods concurrent embedded design to describe parish nurses' experiences with diabetes education and preconception counseling in their practice. Also included were descriptions of generalized practices. Therefore, this current report will focus on these broader experiences. Focus group data were collected using face-to-face, teleconference, and video conferencing formats with 48 nurses who consider themselves to be parish nurses and analyzed with content analysis. FINDINGS: Four qualitative themes were identified in the data: (1) Gaining Entry Through Trust, (2) Enhanced Focus on Spiritual Caring, (3) Accomplishing Much Despite Challenges, and (4) Practice Making a Difference. Parish nurses are uniquely situated to provide holistic care for the mind, body, and spirit of their patients. Despite the many positive aspects, parish nurses experience unique challenges, such as funding their practice and working independently. CONCLUSIONS: The parish nurses can play a vital role in providing holistic care to patients in a faith-based community. Future work is needed to address the challenges of parish nurses such as access to continuing education programs related to health topics of concern to their community members.

Dietary Behaviors and Glucose Metabolism in Young Adults at Risk for Type 2 Diabetes.

Purpose The purpose of the study was to examine the associations between dietary behaviors and glucose metabolism in high-risk young adults to increase the precision of nutrition education to prevent early onset type 2 diabetes (T2D). Method Using a descriptive, cross-sectional study design, 106 overweight or obese sedentary young adults ages 18-29 years from the Atlanta metropolitan area were recruited to screen diabetes risk. Survey questionnaires, anthropometric assessment, blood pressure (BP), and laboratory data were collected in a clinical research unit. The Web-based HOMA2 calculator was used to calculate beta cell function and insulin sensitivity. Results The final sample included 103 participants. There were similar patterns of diet (caloric intake and dietary quality) between African Americans and non-African Americans, whereas African Americans showed hyperinsulinemia compared with non-African Americans. When young adults consumed a good quality diet (appropriate carbohydrate intakes; high fiber, low saturated fat but protein rich diet), their insulin resistance was decreased. There was a marginal interaction effect between insulin sensitivity and beta cell function by race. Systolic BP was higher in African Americans, and total cholesterol, triglycerides, and low-density lipoprotein cholesterol were higher in non-African Americans. Conclusion Findings are useful to develop age-specific nutrition guidelines to prevent early onset T2D in high-risk young adults.

Pregnancy Weight Gain by Gestational Age in Women with Uncomplicated Dichorionic Twin Pregnancies.

BACKGROUND: Twin pregnancies are at increased risk for adverse outcomes and are associated with greater gestational weight gain compared to singleton pregnancies. Studies that disentangle the relationship between gestational duration, weight gain and adverse outcomes are needed to inform weight gain guidelines. We created charts of the mean, standard deviation and select percentiles of maternal weight gain-for-gestational age in twin pregnancies and compared them to singleton curves. METHODS: We abstracted serial prenatal weight measurements of women delivering uncomplicated twin pregnancies at Magee-Womens Hospital (Pittsburgh, PA, 1998-2013) and merged them with the hospital's perinatal database. Hierarchical linear regression was used to express pregnancy weight gain as a smoothed function of gestational age according to pre-pregnancy BMI category. Charts of week- and day-specific values for the mean, standard deviation, and percentiles of maternal weight gain were created. RESULTS: Prenatal weight measurements (median: 11 [interquartile range: 9, 13] per woman) were available for 1109 women (573 normal weight, 287 overweight, and 249 obese). The slope of weight gain was most pronounced in normal weight women and flattened with increasing pre-pregnancy BMI (e.g. 50th percentiles of 6.8, 5.7, and 3.6 kg at 20 weeks and 19.8, 18.1, and 14.4 at 37 weeks in normal weight, overweight, and obese women, respectively). Weight gain patterns in twins diverged from singletons after 17-19 weeks. CONCLUSIONS: Our charts provide a tool for the classification of maternal weight gain in twin pregnancies. Future work is needed to identify the range of weight gain associated with optimal pregnancy health outcomes.

Promoting Healthy Eating Among African-American School-Aged Girls in a Community Setting.

The prevention of obesity is vital to the health of American children. In the urban African-American community, the health of school-aged children is in particular jeopardy due to the high prevalence of obesity, type 2 diabetes, and poor dietary choices such as the purchase of sugary drinks, salty snacks, low consumption of fresh fruits and vegetables, and reliance on fast food meals. African-American girls are at a higher risk for obesity and early puberty before age 10, placing them at a greater risk for diabetes and cardiovascular disease in adulthood. Our current "Cooking with Kids" program in a local grocery store has allowed us to promote healthy eating behavior in a unique way; teaching 6 through 11-year-olds how to prepare easy healthy breakfasts, lunches, and snack food recipes at a local grocery store while their mothers shopped.

Experiences of Parish Nurses in Providing Diabetes Education and Preconception Counseling to Women With Diabetes.

OBJECTIVE: To explore the role and experiences of the parish nurse in providing diabetes education and preconception counseling to women with diabetes. DESIGN: Mixed-methods concurrent embedded design. SETTING: Focus groups of community-based parish nurses accessed from a regional database (Pennsylvania, Florida, Ohio, New York, Arizona, and Minnesota). PARTICIPANTS: Forty-eight parish nurses recruited from the Parish Nurse and Health Ministry Program database in Western Pennsylvania. METHODS: The primary method was focus groups using face-to-face, teleconference, and videoconferencing formats. A secondary method used a quantitative descriptive design with three self-report measures (demographic, preconception counseling self-efficacy, and preconception counseling knowledge). Qualitative content analysis techniques were conducted and combined with descriptive analysis. RESULTS: Forty-eight parish nurses participated in 1 of 11 focus groups. Eight qualitative themes emerged: Awareness, Experience, Formal Training, Usefulness, Willingness, Confidence, "Wise Women," and Preconception Counseling Tool for Patients. Participants provided recommendations for training and resources to increase their knowledge and skills. Parish nurses' knowledge scores were low (mean = 66%, range = 40%-100%) with only moderate levels of self-efficacy (mean = 99, range = 27-164). Self-efficacy had a significantly positive association with knowledge (r = .29, p = .05). CONCLUSION: Quantitative results were consistent with participants' qualitative statements. Parish nurses were unaware of preconception counseling and lacked knowledge and teaching self-efficacy as it related to preconception counseling and diabetes education. Understanding parish nurses' experiences with women with diabetes and identifying their needs to provide education and preconception counseling will help tailor training interventions that could affect maternal and fetal outcomes.

Understanding How Overweight and Obese Emerging Adults Make Lifestyle Choices.

To better understand health-related decision making among overweight and obese emerging adults. DESIGN AND METHODS: A cross-sectional design was used in the parent study involving overweight and obese emerging adults, ages 18-29 years. The goal of the parent study was to screen participants' diabetes risk and identify characteristics of emerging adults with prediabetes (N=107). A sub-sample of respondents (n=34) from the parent study were invited to participate in focus group interviews depending on whether they had prediabetes (three groups) or they did not have prediabetes (four groups). Each focus group interview lasted 90-120 minutes following a semi-structured interview guide. Conventional content analysis was used in the data analysis. Because of the similarities between participants with and without prediabetes, the findings were synthesized and reported in the aggregate. Moreover, during the analysis, the authors decided that rational choice theory provided a useful organizing structure for presenting the data. RESULTS: Emerging adults' behavioral decisions were rational reactions to their personal competence, perception of health, environment, and availability of resources to handle problems. Calculation of trade-offs and estimations of resource availability were often used when making decisions. CONCLUSIONS: Emerging adults choose unhealthy behaviors due to inaccurate information and insufficient competence to practice healthy lifestyles rather than because of laziness or being irrational. PRACTICE IMPLICATIONS: Behavioral interventions for emerging adults need to help them develop skills to enhance health literacy and problem solving, thereby enhancing their awareness of available resources and decreasing the perceived cost of making healthy choices.

Preventive strategies to reduce depressive symptoms in overweight and obese young adults.

This study examined the relationships among problem-solving, physical activity self-efficacy, leisure-time physical activity, and depressive symptoms in overweight/obese young adults vulnerable to many health risks. Data from 96 young adults were used. The mean age and body mass index were 24.0±3.3 years old, and 36.9±7.9, respectively. There was a positive association between physical activity self-efficacy and leisure-time physical activity in African Americans, but not in non-African Americans. Better problem solving was associated with fewer depressive symptoms regardless of gender and race.

Nursing students' experiences with screening, brief intervention, and referral to treatment for substance use in the clinical/hospital setting.

Although Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an effective early intervention when used across healthcare settings, its implementation has been difficult, in part because of lack of training, healthcare providers' feelings of low self-efficacy in performing SBIRT, and negative attitudes about people who use alcohol and drugs. This study used qualitative descriptive methods to examine baccalaureate nursing students' experiences with practicing SBIRT in clinical rotations following in-depth classroom work and skill-based training. Fifty-five junior level nursing students participated in four focus groups. Three overarching themes describe students' experiences with SBIRT. Students expressed a positive impact of the training on their attitudes and feelings of self-efficacy regarding the use of SBIRT, differences in opinions about whether SBIRT should be used universally with all patients or as a targeted intervention with only some patients, and that SBIRT is a nursing responsibility. These results suggest that education and training can affect attitudes and efficacy, but that attention needs to be paid to how SBIRT is implemented within different healthcare settings.

Breastfeeding and short sleep duration in mothers and 6-11-month-old infants.

This study examined breastfeeding and sleep in 77 dyads of mothers and infants 6-11 months old. Data revealed no significant difference in sleep patterns between breastfed and non-breastfed infants. Controlling for variables including breastfeeding status, only infant nighttime sleep duration was significant in predicting maternal short sleep duration.

Testing the theory of reasoned action in explaining sexual behavior among African American young teen girls.

This study tested the Theory of Reasoned Action to examine the prediction of early sexual behavior among African American young teen girls. Baseline data from a longitudinal randomized clinical trial were used. Between 2001 and 2005, 198 middle-school girls aged 11 to 14 years were recruited. As girls aged, they held more permissive attitudes toward engaging in early sexual behavior and had a higher intention to engage in early sexual behavior. Intention was a significant predictor to explain sexual behavior among the girls. There is a need to develop strategies that promote intention related to delay and prevention of early sexual behavior.

Another look at heterosocial behaviors: one side of the early intimate sexual behaviors coin.

The number of adolescent births is once again on the rise. Heterosocial competence described as successful interactions (i.e., heterosocial behaviors) with males (Grover, Nangler, & Zeff, 2005; Grover, Nangler, Serwik, & Zeff, 2007) is one emerging factor that has been found to be associated with adolescent sexual behavior. The aims of this cross sectional design study with 159 African American middle-school girls using the theory of reasoned action (Ajzen & Fishbein, 1980) were to describe and assess the relationship between heterosocial behaviors and sexual behaviors. Data was obtained using four surveys. The results suggest that heterosocial behaviors were a significant predictor of sexual behaviors (p < .001).