Did rest breaks help with acute fatigue among nursing staff on 12-h shifts during the COVID-19 pandemic? A cross-sectional study.

AIM: This study aimed to explore whether 30-min rest breaks were as effective at lowering acute fatigue among 12-h shift hospital nursing staff who cared for patients with COVID-19 as among those who did not. DESIGN: The study was cross-sectional in design. METHODS: Data from the SAFE-CARE study collected online between May and June 2020 were used. A subsample (N = 338) comprised of nursing staff who reported working 12-h shifts, and providing direct patient care in hospitals was used in this study. Data on socio-demographics, work and rest breaks, and subjective measures of fatigue, psychological distress, sleep and health were used. Hierarchical multiple linear regression followed by stratified analyses was conducted to explore the relationships between rest breaks and acute fatigue among nursing staff groups with and without COVID-19 patient care. RESULTS: The sample, on average, had high acute fatigue. Around 72% reported providing care to patients with COVID-19, and 71% reported taking rest breaks 'sometimes', 'often' or 'always'. In the group that cared for patients with COVID-19, there was no significant relationship between rest breaks and acute fatigue (p = .507). In the group that cared for patients hospitalized for other reasons, rest breaks were associated with lower acute fatigue (p = .010). CONCLUSION: Our findings showed both the importance and inadequacy of rest breaks in reducing acute fatigue. The process of within-work recovery is complex, and routine rest breaks should be facilitated by nursing management on hospital units during and after the COVID-19 pandemic. IMPACT: Rest breaks may present an effective strategy in lowering fatigue. Although rest breaks were not associated with less fatigue among staff caring for patients with COVID-19, other co-workers experienced some fatigue recovery. For frontline nursing staff, routine rest breaks are encouraged, and a systematic evaluation pertaining the sufficiency of rest breaks during high work demands in future research is needed.

Long-Term Effects of Truancy Diversion on School Attendance: a Quasi-Experimental Study with Linked Administrative Data.

Over 60% of US school districts implement court diversion programs to address chronic unexcused absenteeism, yet the effectiveness of these programs is not known. We evaluated whether the Truancy Intervention Program (TIP) improved the school attendance of students in grades 7-10 in a metropolitan county in the Midwestern USA. Similar to most truancy court diversion programs, TIP consisted of three increasingly intrusive steps: (1) a parent meeting, (2) a hearing to develop an attendance contract, and (3) a petition to juvenile court. The intervention group consisted of students from the intervention county who had been referred to TIP between 2006 and 2009. The comparison group was drawn from a contiguous, same-sized, and socio-demographically similar county that petitioned truant students directly to court. To construct the comparison group, we applied multi-level matching procedures to linked, individual-level administrative data from eight state and local agencies for all public school students in the state between 2004 and 2015. Using the matched samples, we conducted difference-in-differences analyses to identify program effects for two intervention groups: all students referred to TIP and students whose family participated in the group parent meeting. In the 4 years after the intervention, the intervention groups had similar or slightly lower attendance than the comparison groups. However, most coefficients were not statistically significant, and there was no consistent pattern of effects across different samples and different specifications of the intervention. This pattern of findings was not robust enough to conclude that the program influenced school attendance.

Expanding Contraceptive Access for Women With Substance Use Disorders: Partnerships Between Public Health Departments and County Jails.

CONTEXT: Law enforcement has been the primary strategy for addressing the opioid epidemic. As a result, the incarceration rate for women in county jails has increased more than 800% since 1980, and most women inmates struggle with substance use disorders. There is a large unmet need for contraception among women in county jails. PROGRAM: The East Region of the Tennessee Department of Health partnered with county correctional facilities to provide comprehensive family planning education and voluntary long-acting reversible contraception (LARC) to women in 15 jails. IMPLEMENTATION: Incarcerated women were invited to attend a comprehensive family planning education session conducted in the jail by health department nurses. The sessions included information on neonatal abstinence syndrome. The nurses explained that the women could receive intrauterine devices, implants, and injectable progesterone while incarcerated and come to the health department for all contraceptive methods upon release. Between January 2014 and June 2017, nurses conducted 182 education sessions, and 794 women received a LARC. Method placement occurred in the jails or at the local health department. No adverse effects were known to have occurred. EVALUATION: We collected pilot data to explore the accuracy and the comprehensiveness of the family planning education session and whether the incarcerated women experienced the program as voluntary. All 18 women inmates interviewed reported experiencing the program as voluntary. Using published and administrative data, we roughly estimated that the program prevented between 270 and 460 unintended pregnancies and between 40 and 52 cases of neonatal abstinence syndrome in the first year after the women received a method. This represents a cost savings to Medicaid of $1.4 million. DISCUSSION: The partnership demonstrated the feasibility of providing voluntary comprehensive family planning education and access to highly effective contraception for women inmates who, as a group, face a host of political, socioeconomic, and personal barriers to reproductive health care.

Long-Term Health Consequences of Movement Restrictions for Palestinians, 1987-2011.

OBJECTIVES: To estimate the long-term association between Israeli-imposed restrictions on travel for medical care in the occupied Palestinian territory and health status in adulthood. METHODS: Using event history calendar methods, we collected annual data from 1987 to 2011 from a representative sample of 1778 Palestinians aged 32 to 43 years and analyzed the subsample of whomever had a serious medical condition and needed to travel for medical care (n = 246; contributing 1163 person-years). We used ordered logistic regression with person-year data to test the association between movement restrictions from 1987 to 2011 and health status in 2011. RESULTS: Two thirds (65%; n = 161) of participants reported travel restrictions, and 38% (n = 92) reported ever being barred from travel for medical care. Compared with study participants who experienced no travel restrictions in a year (n = 559 person-years), those who were barred from travel in that same year (n = 122 person-years) reported worse self-rated health (57% vs 22% reported bad or very bad self-rated health; P < .05) and greater limits on daily functioning caused by physical health (41% vs 16% reported regular limits; P < .05). CONCLUSIONS: Being barred from travel for medical care was associated with poor health as long as 25 years later.

Feeling disrespected by parents: refining the measurement and understanding of psychological control.

This study investigated parental psychological control of adolescents when construed as disrespect of individuality. First, 120 adolescents from 5 cultures were interviewed and asked to identify specific parental behaviors that communicated to them that they were disrespected as individuals. The interview data were coded and 8 new survey items were constructed to reflect key content. These items were then administered to 2100 adolescents in the same cultures along with a traditional measure of psychological control (PCS). Confirmatory factor analyses indicated that model fit was better when the two scales were kept separate, across culture and sex of parent. In structural equation models, the new scale - labeled Psychological Control - Disrespect - accounted for all and more of the variance in youth depression and antisocial behavior than the PCS did. The discussion centers on the validation the study makes of the construct and offers several suggestions for future research.

Barriers to recruitment and retention of undergraduate men as college sexual assault prevention peer educators.

Objective: Male allies play an important role in sexual assault prevention, yet many college sexual assault prevention programs struggle to recruit and retain men. This study aims to identify barriers to recruitment and retention of male sexual assault prevention peer educators. Participants: Seventeen undergraduate male student leaders participated in this study during summer 2018. Methods: Semi-structured phone interviews were conducted, recorded, and transcribed. Response data were thematically analyzed. Results: Barriers to recruitment include perceived gender norms and discomfort with the topic of sexual assault. Barriers to retention include male peer educators' perception that women are resistant to men discussing sexual assault. Suggestions for improving recruitment and retention efforts are also identified. Conclusions: Recruitment and retention of male sexual assault prevention peer educators may require recruitment approaches that are tailored to men and programmatic changes that position men as allies in sexual assault prevention.

The role of structure versus individual agency in churches' responses to HIV/AIDS: a case study of Baltimore City churches.

This paper examines the activities of churches in Baltimore, Maryland, concerning the issues of sexuality, whether they potentially stigmatize persons with or at risk for HIV/AIDS, and to what extent individual agency versus institutional forces influence churches in this regard. In-depth interviews were conducted with 20 leaders from 16 churches and analyzed using a grounded theory methodology. Although many churches were involved in HIV/AIDS-related activities, the content of such initiatives was sometimes limited due to organizational constraints. Church leaders varied, however, in the extent to which they responded in accordance with or resisted these constraints, highlighting the importance of individual agency influencing churches' responses to HIV/AIDS.

Identifying Essential Components of School-Linked Mental Health Services for Refugee and Immigrant Children: A Comparative Case Study.

BACKGROUND: Foreign-born children rarely use traditional school mental health services. Comprehensive programs that combine mental health services with academic, economic, and socioemotional supports reach more foreign-born children and improve wellbeing. However, little practical guidance exists regarding how to best combine these diverse services. METHODS: To identify essential service components and their organization, we interviewed 92 parents, school staff, mental health providers, and community agency staff from 5 school-linked mental health programs designed specifically to serve immigrant and refugee youth. RESULTS: Foreign-born parents did not distinguish between academic, behavioral, and emotional help for their children; these western categorizations of functioning were not meaningful to them. Consequently, programs needed to combine 4 components, organized in a pyramid: family engagement, assistance with basic needs, assistance with adaptation to a new culture, and emotional and behavioral supports. Family engagement was the foundation upon which all other services depended. Assistance with economic and cultural stressors directly promoted emotional wellbeing and helped parents trust clinical mental health interventions. CONCLUSIONS: Specific strategies to implement the 4 essential components include home visits by program staff, a one-stop parent center located in the school to help with basic needs, working with cultural brokers, and informed consent procedures that clearly explain recommended care without requiring immigrant and refugee parents to internalize western conceptualizations of psychopathology. Future evaluations should assess the cost and effectiveness of these strategies. These data are essential to advocate payment for these nonclinical services by traditional funding mechanisms.

Core competencies and the prevention of school failure and early school leaving.

There is an increasing awareness that school failure and early school leaving are processes, rather than discrete events, that often co-occur and can have lasting negative effects on children's development. Most of the literature has focused on risk factors for failure and dropout rather than on the promotion of competencies that can increase youths' likelihood of successfully completing high school. This chapter applies the core competencies framework to the promotion of youths' success within the school environment. We conclude with a brief review of evidence-based prevention strategies that address the five competencies and identify avenues for future research.

Do restrictive omnibus immigration laws reduce enrollment in public health insurance by Latino citizen children? A comparative interrupted time series study.

In the United States, there is concern that recent state laws restricting undocumented immigrants' rights could threaten access to Medicaid and the Children's Health Insurance Program (CHIP) for citizen children of immigrant parents. Of particular concern are omnibus immigration laws, state laws that include multiple provisions increasing immigration enforcement and restricting rights for undocumented immigrants. These laws could limit Medicaid/CHIP access for citizen children in immigrant families by creating misinformation about their eligibility and fostering fear and mistrust of government among immigrant parents. This study uses nationally-representative data from the National Health Interview Survey (2005-2014; n = 70,187) and comparative interrupted time series methods to assess whether passage of state omnibus immigration laws reduced access to Medicaid/CHIP for US citizen Latino children. We found that law passage did not reduce enrollment for children with noncitizen parents and actually resulted in temporary increases in coverage among Latino children with at least one citizen parent. These findings are surprising in light of prior research. We offer potential explanations for this finding and conclude with a call for future research to be expanded in three ways: 1) examine whether policy effects vary for children of undocumented parents, compared to children whose noncitizen parents are legally present; 2) examine the joint effects of immigration-related policies at different levels, from the city or county to the state to the federal; and 3) draw on the large social movements and political mobilization literature that describes when and how Latinos and immigrants push back against restrictive immigration laws.

How Schools Can Promote Healthy Development for Newly Arrived Immigrant and Refugee Adolescents: Research Priorities.

BACKGROUND: The US education system must find creative and effective ways to foster the healthy development of the approximately 2 million newly arrived immigrant and refugee adolescents, many of whom contend with language barriers, limited prior education, trauma, and discrimination. We identify research priorities for promoting the school success of these youth. METHODS: The study used the 4-phase priority-setting method of the Child Health and Nutrition Research Initiative. In the final stage, 132 researchers, service providers, educators, and policymakers based in the United States were asked to rate the importance of 36 research options. RESULTS: The highest priority research options (range 1 to 5) were: evaluating newcomer programs (mean = 4.44, SD = 0.55), identifying how family and community stressors affect newly arrived immigrant and refugee adolescents' functioning in school (mean = 4.40, SD = 0.56), identifying teachers' major stressors in working with this population (mean = 4.36, SD = 0.72), and identifying how to engage immigrant and refugee families in their children's education (mean = 4.35, SD = 0.62). CONCLUSION: These research priorities emphasize the generation of practical knowledge that could translate to immediate, tangible benefits for schools. Funders, schools, and researchers can use these research priorities to guide research for the highest benefit of schools and the newly arrived immigrant and refugee adolescents they serve.

Public and private domains of religiosity and adolescent smoking transitions.

We used data from a nationally representative sample of US adolescents in school grades 7 through 12 to explore the effects of public and private religiosity on initiation, escalation, and cessation of smoking. We found that adolescents' decisions to experiment with smoking are influenced by both their individual practice of their faith and by participation in a larger faith community. However, the effects of private and public religiosity are specific to different decision points on the smoking uptake process. Private religiosity was protective against initiation of regular smoking among nonsmokers. It also was protective against initiation of experimental smoking but only when the young person frequently attended religious services or a religious youth group. Although private religiosity appeared to discourage the uptake of smoking, it was unrelated to reduction or cessation once a young person has become addicted to cigarettes. In contrast, public religiosity did predict reduction and cessation of cigarette use among regular smokers. Taken together, these findings demonstrate that the domains in which religiosity are important extend beyond the individual and include religious institutions.

Self-Rated Health Across Race, Ethnicity, and Immigration Status for US Adolescents and Young Adults.

PURPOSE: Health disparities research seeks to understand and eliminate differences in health based on social status. Self-rated health is often used to document health disparities across racial/ethnic and immigrant groups, yet its validity for such comparative research has not been established. To be useful in disparities research, self-rated health must measure the same construct in all groups, that is, a given level of self-rated health should reflect the same level of mental and physical health in each group. This study asks, Is the relationship between self-rated health and four indicators of health status--body mass index, chronic conditions, functional limitations, and depressive symptoms--similar for adolescents and young adults of different races/ethnicities and immigrant generations? METHODS: Ordinary least squares regression was used to examine associations of self-rated health with the four indicators of health status both cross-sectionally and longitudinally using four waves of the National Longitudinal Study of Adolescent to Adult Health. RESULTS: Health indicators explained similar amounts of variance in self-rated health for all racial/ethnic and immigrant generation groups. The cross-sectional association between the health indicators and self-rated health did not vary across groups. The longitudinal association between depressive symptoms and chronic conditions and self-rated health also did not differ across groups. However, an increase in body mass index was associated more negatively with later self-rated health for Asians than for whites or blacks. CONCLUSIONS: Self-rated health is valid for disparities research in large, population-based surveys of US adolescents and young adults. In many of these surveys self-rated health is the only measure of health.

Mental Suffering in Protracted Political Conflict: Feeling Broken or Destroyed.

PURPOSE: This mixed-methods exploratory study identified and then developed and validated a quantitative measure of a new construct of mental suffering in the occupied Palestinian territory: feeling broken or destroyed. METHODS: Group interviews were conducted in 2011 with 68 Palestinians, most aged 30-40, in the West Bank, East Jerusalem, and the Gaza Strip to discern local definitions of functioning. Interview participants articulated of a type of suffering not captured in existing mental health instruments used in regions of political conflict. In contrast to the specific difficulties measured by depression and PTSD (sleep, appetite, energy, flashbacks, avoidance, etc.), participants elaborated a more existential form of mental suffering: feeling that one's spirit, morale and/or future was broken or destroyed, and emotional and psychological exhaustion. Participants articulated these feelings when describing the rigors of the political and economic contexts in which they live. We wrote survey items to capture these sentiments and administered these items-along with standard survey measures of mental health-to a representative sample of 1,778 32-43 year olds in the occupied Palestinian territory. The same survey questions also were administered to a representative subsample (n = 508) six months earlier, providing repeated measures of the construct. RESULTS: Across samples and time, the feeling broken or destroyed scale: 1) comprised a separate factor in exploratory factor analyses, 2) had high inter-item consistency, 3) was reported by both genders and in all regions, 4) showed discriminate validity via moderate correlations with measures of feelings of depression and trauma-related stress, and 5) was more commonly experienced than either feelings of depression or trauma-related stress. CONCLUSIONS: Feeling broken or destroyed can be reliably measured and distinguished from conventional measures of mental health. Such locally grounded and contextualized measures should be identified and included in assessments of the full impact of protracted political conflict on functioning.

Public and private domains of religiosity and adolescent health risk behaviors: evidence from the National Longitudinal Study of Adolescent Health.

The purpose of this study was to examine the association of public and private domains of religiosity and adolescent health-related outcomes using data from the National Longitudinal Study of Adolescent Health (Add Health), a nationally representative sample of American adolescents in grades 7-12. The public religiosity variable combines two items measuring frequency of attendance at religious services and frequency of participation in religious youth group activities. The private religiosity variable combines two items measuring frequency of prayer and importance of religion. Our results support previous evidence that religiosity is protective for a number of adolescent health-related outcomes. In general, both public and private religiosity was protective against cigarettes, alcohol, and marijuana use. On closer examination it appeared that private religiosity was more protective against experimental substance use, while public religiosity had a larger association with regular use, and in particular with regular cigarette use. Both public and private religiosity was associated with a lower probability of having ever had sexual intercourse. Only public religiosity had a significant effect on effective birth control at first sexual intercourse and, for females, for having ever been pregnant. However, neither dimension of religiosity was associated with birth control use at first or most recent sex. Public religiosity was associated with lower emotional distress while private religiosity was not. Only private religiosity was significantly associated with a lower probability of having had suicidal thoughts or having attempted suicide. Both public and private religiosity was associated with a lower probability of having engaged in violence in the last year. Our results suggest that further work is warranted to explore the causal mechanisms by which religiosity is protective for adolescents. Needed is both theoretical work that identifies mechanisms that could explain the different patterns of empirical results and surveys that collect data specific to the hypothesized mechanisms.

Promoting school connectedness: evidence from the National Longitudinal Study of Adolescent Health.

Increasing evidence shows that when adolescents feel cared for by people at their school and feel like a part of their school, they are less likely to use substances, engage in violence, or initiate sexual activity at an early age. However, specific strategies to increase students' connectedness to school have not been studied. This study examined the association between school connectedness and the school environment to identify ways to increase students' connectedness to school. Data from the in-school and school administrator surveys of the National Longitudinal Study of Adolescent Health (75,515 students in 127 schools) and hierarchical linear models were used to estimate the association between school characteristics and the average level of school connectedness in each school. Positive classroom management climates, participation in extracurricular activities, tolerant disciplinary policies, and small school size were associated positively with higher school connectedness.

A rose by any other name? Objective knowledge, perceived knowledge, and adolescent male condom use.

OBJECTIVE: To investigate the role of objective and perceived knowledge about condoms in adolescent males' condom use at first intercourse. METHODS: A longitudinal analysis was conducted of data from a nationally representative sample of 404 virgin male adolescents who were aged 15 to 17 years at wave 1 and reported becoming sexually experienced at the second wave of data collection. Objective knowledge was measured as a 5-item knowledge test about condoms. Perceived knowledge was measured as a 5-item scale regarding participants' confidence about their answers on the objective knowledge test. Condom use was assessed by self-report. RESULTS: Objective and perceived knowledge were moderately correlated with each other. Male adolescents with low objective but high perceived knowledge were identified as being at particular risk for not using a condom in that they were nearly 3 times less likely to report using a condom at first intercourse (odds ratio: 0.35) than those with other levels of objective and perceived knowledge. CONCLUSIONS: Previous evidence suggests that knowledge about sex does not accurately predict sexual behavior. This lack of predictive accuracy may be because studies have focused only on objective knowledge. Our results suggest that both objective and perceived knowledge serve as antecedents to male condom use at first intercourse. However, those with higher perceived knowledge, particularly in the context of low objective knowledge, may be at greater risk for not using condoms. Addressing not only objective but also perceived knowledge may increase the effectiveness of interventions that are designed to increase rates of condom use among male adolescents.