Demographics of sexual orientation among American-Indian adolescents.

Self-report of sexual orientation and sexual behavior was compared for 12,978 reservation-based American-Indian and 11,356 rural Anglo-American adolescents. Findings included a significantly higher prevalence of homosexual, bisexual, and unsure responses among American Indians. However, a larger nonresponse rate for American-Indian adolescents raises questions about the cultural relevance of the survey method, and underscores the need for development of more culturally sensitive research tools and methods.

Sexual orientation, sexual behaviors, and pregnancy among American Indian adolescents.

PURPOSE: A recent study found a disproportionate number of pregnancies among Euro-American lesbian and bisexual adolescents compared to heterosexual peers. American Indian adolescents have reported higher prevalence of gay/lesbian/bisexual orientations than Euro-Americans; do they also report higher prevalence of pregnancy? METHODS: The study assessed prevalence of teen pregnancy and related factors by sexual orientation among sexually experienced, reservation-based American Indian adolescent males (n = 2056) and females (n = 1693) who participated in a national school-based survey in 1991. Self-reported orientation was classified as heterosexual, gay/lesbian/bisexual, and "unsure" of orientation. RESULTS: Gay/bisexual males were more likely than other males to report early heterosexual intercourse (<14 years), more consistent contraception, and a higher prevalence of abuse and running away (p < 0.05 to p < 0.0001). Likewise, lesbian/bisexual females were more likely to report early onset of heterosexual intercourse, more frequent intercourse, and running away. Sexual or physical abuse did not vary by orientation for females. Prevalence of pregnancy also did not vary by orientation (males, 18.6% gay/bisexual vs. 10.4% "unsure" vs. 11.8% heterosexual; females, 25.0% lesbian/bisexual vs. 22.1% "unsure" vs. 21.9% heterosexual). For lesbian/bisexual females, no variables were significantly associated with pregnancy history; for "unsure" females, pregnancy was associated with contraceptive frequency and early onset of heterosexual activity. For heterosexual females, age, intercourse frequency, and physical abuse were associated. For gay/bisexual males, intercourse frequency, ineffective contraception, and physical abuse were associated with involvement in a pregnancy; for "unsure" and heterosexual males, most items except ineffective contraception were related to pregnancy involvement history. CONCLUSIONS: Although prevalence of pregnancy is similar, findings show group differences in associated risk factors by sexual orientation. Interventions to reduce pregnancy among American Indian adolescents should include assessment of sexual orientation and behavioral risk factors.

Self-management development in children and adolescents with diabetes: the role of maternal self-efficacy and conflict.

The overall purpose of this study was to investigate maternal self-efficacy and its relationship to maternal perception of the child's self-management of diabetes. The influence of conflict between mother and child was also examined. One hundred and four mothers of children, ages 8 to 17 years, who were attending summer diabetes camp, were asked to rate their own and their child's abilities to manage the child's diabetes. Overall, the mothers expressed a high degree of self-efficacy in managing their child's diabetes and perceived their children as average or above in managing their own diabetes when compared with agemates with diabetes. Furthermore, mother's level of self-efficacy was significantly positively related to their perceptions of their child's self-management. In addition, almost one third (30%) of the mothers reported experiencing interpersonal conflict regarding how much responsibility the child should assume in managing their own diabetes. Mothers who rated their child's level of independence as low were three times more likely to report experiencing conflict. In the vast majority of cases, the child was the primary source of conflict. When hierarchical logistic regression was used to multivariately model children's independence, conflict with the child remained a significant predictor, above and beyond background, demographic, and important conceptual variables, including self-efficacy.

Dimensions of risk behaviors among American Indian youth.

OBJECTIVE: To explore the covariation of risk behaviors in a national sample of American Indian reservation-based youth using listwise principal components factor analysis and to determine how these risk behaviors may vary by age and sex. DESIGN: Analysis of data from the National Indian Adolescent Health Survey, a validated anonymous self-report questionnaire of 162 items addressing various health domains. SETTING: The survey was administered nationally in more than 200 reservation-based schools. PARTICIPANTS: Thirteen thousand nine hundred twenty-three reservation-based American Indian or Alaska Native students in grade 7 through 12 representing more than 50 tribes. The listwise factor analysis sample included 7687 respondents with complete data. MAIN OUTCOME MEASURES: Item loading and factor correlations by age and sex for 30 risk behaviors across various health domains. RESULTS: Three risk behavior factors were fairly stable across sex and age: (1) the use of alcohol, tobacco, and other drugs; (2) risky sexual behavior, and (3) suicidal behaviors. Correlations between these and other factors suggested different strengths of relationships by sex and age. Other factors, including violence, truancy, and delinquency, showed differences in item loading on factors and correlations between factors. The use of tobacco, alcohol, and other drugs was most frequently associated with other risk behavior factors, and suicidal behaviors showed the next highest frequency of intercorrelations. CONCLUSIONS: There are sex and age differences in the covariation of risk behaviors, and suicidal behaviors should be further investigated to determine of our findings are unique to American Indian youth. Health interventions that focus categorically on 1 risk dimension should also emphasize substance use prevention and intervention. To prevent substance abuse among American Indian youth, research efforts need to focus on effective strategies for coping with social and psychological stressors.

Extended hospitalization of medically stable children dependent on technology: a focus on mutable family factors.

This study identified three factors that influenced extended hospital stay in medically stable children dependent on medical technology. A retrospective review of 50 charts in a level II nursery was conducted. Bivariate analysis identified factors contributing to extended stay: parental factors, societal factors, health care factors, and presence of disease. Multiple regression explained 98% of the variance in extended length of stay. Family factors accounted for 19.6%, nonfamily factors accounted for 42.5%, and the two sets of factors together accounted for an additional 35.9%. Family-related issues with a high potential for change were identified. Pediatric providers should develop family intervention strategies that identify the most appropriate level of care that both advocates in the best interest of the child and family and contains the rising cost of health care.

Comparison of mother-father perceptions of their child's self-management of diabetes.

This study compared mothers' and fathers' perceptions of their children's self-management of diabetes. Participants included a subsample of 29 paired parents of children and youth with diabetes, ages 8-14, who attended a diabetes camp in the Midwest. Parents completed a self-report structured questionnaire that included content specific to self-management. Results showed high ratings for child responsibility for self-management, style of care delivery, and mother-father self-efficacy in managing specific tasks of diabetes self-management. Although overall ratings were similar, in the majority of measures mothers' ratings were higher than fathers' ratings. Areas of similarity and significant differences in perceptions are identified with implications for practice stated.

Differences between nursing home admissions and residents.

The use of a cross-sectional sample of nursing home residents rather than a sample of admissions to estimate admission characteristics carries a potential bias. The purpose of this study was to fill this void by comparing abstracted records data for an admissions cohort (n = 1,118) and a residents cohort (n = 830) residing in the same nursing homes. Compared to residents, admissions were significantly more dependent in their ability to get around and to dress themselves, received more clinical services, and had a higher rate of medication use. Over a 12-month period, admissions had a fivefold greater likelihood of being discharged to community, but about the same mortality rate as residents. Within both groups, those discharged to the community as well as those who died had expenditures that were almost twice as high as those of their counterparts who remained alive in the nursing home.

Improving primary care in nursing homes.

We conducted a quasi-experiment to evaluate the impact of a Medicare waiver which allowed the use of nurse practitioners (NPs) and physicians assistants (PAs) to deliver primary care to Massachusetts nursing home patients and removed the limits on the reimbursable numbers of visits per month. A carefully matched set of 1,327 Medicaid patients from 95 non-participating homes in the same areas of Massachusetts was compared to 1,324 Medicaid demonstration patients from 75 homes. Information came from specially designed record reviews and the Medicaid and Medicare information systems. Separate analyses were done for newly admitted cases and rollovers. Comparisons of quality of care suggested that the medical groups using NPs and PAs provided as good or better care than did the physicians in the control group. There were no differences in functional status changes or in the use of medications. The demonstration patients received more attention, as reflected in more orders written and an average of one additional visit a month. Demonstration patients showed higher scores on three of seven specially designed quality tracers, congestive heart failure and hypertension for both new administrations and rollovers, and new urinary incontinence for new admissions. Rollovers had significantly fewer emergency and total hospital days. A cost analysis suggests that the use of NPs and PAs saves at least as much as it costs and may save additional money with more sustained use.

Impact of geriatric nurse practitioners on nursing-home residents' functional status, satisfaction, and discharge outcomes.

This study evaluated the impact of geriatric nurse practitioners (GNP) employed by nursing homes on quality of patient care and residents' outcomes during a 12-month study period. Quality of care was assessed in standardized interviews of 525 residents in five nursing homes with GNPs and 323 residents in five other nursing homes without GNPs. Each resident was interviewed up to four times during the study period (at baseline, and 3, 6, and 12 months later) to determine functional status, satisfaction with care, and physical condition at each of these points. The only significant difference between groups was that fewer newly admitted residents were hospitalized from GNP homes than from those without a GNP. The results of this interview study showed that the GNP as a nursing home employee had little impact on residents' functional status, physical condition, or satisfaction.

Career paths of geriatric nurse practitioners employed in nursing homes.

The career paths of geriatric nurse practitioners (GNPs) trained with support from the W. K. Kellogg Foundation through the Mountain States Health Corporation (MSHC) were studied. Under this program, GNPs were recruited from sponsoring nursing homes and returned to GNP positions in the sponsoring facilities following training. Training was carried out under a continuing education model offered through six university-based schools of nursing. Questionnaires were sent to the 111 GNPs trained. Of the 102 respondents, 97 provided complete information about past and present education, work experience, and job functions. The GNPs were women with a median age of 45 years, and they were employed in rural settings in the western United States. More than 45 percent of the nurses had at least a baccalaureate degree at the time of GNP training. The GNPs remained employed in long-term care positions that implemented the practitioner role. The median length of GNP employment in their first jobs after training was more than 4.5 years. The resignation rate from this first position was 1.66 resignations for each 10 years of GNP employment. Job changes were likely to be attributed to organizational changes with subsequent positions shifting toward a diversification of the GNP role. The study demonstrates the success of the MSHC program in introducing and retaining GNPs in nursing homes.

Effects of a geriatric nurse practitioner on process and outcome of nursing home care.

We compared measures of quality of care and health services utilization in 30 nursing homes employing geriatric nurse practitioners with those in 30 matched control homes. Information for this analysis came from reviews of samples of patient records drawn at comparable periods before and after the geriatric NPs were employed. The measures of geriatric nurse practitioner impact were based on comparisons of changes from pre-NP to post-NP periods. Separate analyses were done for newly admitted and long-stay residents; a subgroup of homes judged to be best case examples was analyzed separately as well as the whole sample. Favorable changes were seen in two out of eight activity of daily living (ADL) measures: five of 18 nursing therapies; two of six drug therapies; six of eight tracers. There was some reduction in hospital admissions and total days in geriatric NP homes. Overall measures of medical attention showed a mixed pattern with some evidence of geriatric NP care substituted for physician care. These findings suggest that the geriatric NP has a useful role in nursing home care.