Toward understanding family-related characteristics of young adults with sickle-cell disease or sickle-cell trait in the USA.

AIMS AND OBJECTIVES: To describe the family-related characteristics of young adults with sickle-cell disease or sickle-cell trait prior to taking part in a randomised controlled trial on sickle-cell reproductive health education. BACKGROUND: There is a critical need for educational programmes that target the reproductive needs of young adults with sickle-cell disease or trait. However, little is known about the family-related characteristics (i.e., demographic attributes and reproductive health behaviours) in which these young adults live. DESIGN: A descriptive cross-sectional analysis. METHOD: At study enrolment, 234 young adults (mean age = 25·9 years, 65% female) completed the SCKnowIQ questionnaire. Descriptive statistics depict the demographic attributes and reproductive health behaviours of young adults with sickle-cell disease (n = 138) or trait (n = 96). For group comparisons, independent t tests or Fisher's tests were used, as appropriate. RESULTS: Young adults with sickle-cell trait had significantly higher education, income and health insurance than those with sickle-cell disease. Both groups believed that sickle-cell disease was a severe condition. A majority of young adults with sickle-cell disease (65%) had no children compared to 42% of those with sickle-cell trait. Most young adults (85% sickle-cell disease, 82% sickle-cell trait) were not planning a pregnancy in the next six months, and many used condoms, withdrawal or oral contraceptives. CONCLUSIONS: Socioeconomic disparities exist between young adults with sickle-cell disease and sickle-cell trait. Future research that advances education about how and when to communicate appropriate genetic risk information to partners and children especially for young adults with sickle-cell trait would be beneficial. RELEVANCE TO CLINICAL PRACTICE: Awareness of the similarities and differences in the family-related characteristics among young adults with sickle-cell disease or trait can allow for more tailored reproductive education.

Pursuing a doctorate in nursing: Implications for underrepresented minority nurses.

Making the decision to pursue doctoral studies can be daunting and in some instances life changing. As a dedicated cadre of doctorally prepared minority nurse leaders, we provide mentoring and support to aspiring and current underrepresented minority (URM) doctoral nursing students. Providing support and guidance around doctoral readiness is essential to helping URMS navigate the doctoral nursing education journey.

The Crisis of Sickle Cell Disease in Africa from Insights into Primary Prevention in Ghana and Nigeria: Notes from the Field.

Sickle cell disease (SCD), an inherited blood disorder, impacts 2% of newborns in Nigeria and Ghana. Despite devastating health consequences, SCD prevention is not a priority in either country. This article describes our U.S. research team's feasibility assessment for adapting CHOICES, a computer-based SCD education program, for use in Ghana and Nigeria. We identified indigenous collaborators by reviewing published research and investigating advocacy organizations online. This led to a fact-finding trip to Africa to discuss SCD prevention with local boards of advisors. Three major recommendations emerged from the group discussions: design a culturally appropriate intervention; enlist community healthcare workers to deliver the CHOICES program; and collaborate with religious and community leaders and elders in public awareness campaigns. Based on extensive advisor input, we will modify the content and delivery of the CHOICES intervention to meet the needs of those impacted by SCD in Ghana and Nigeria.

Skills and Strategies of African American Parents in the Management of ADHD: A Qualitative Study.

Objective: The purpose of this study is to use a strengths-based approach to determine African American parents' skills and strategies for management of children with ADHD. Method: Four focus groups were conducted to identify African American parent beliefs about appropriate ADHD management. Sixteen parents participated and reported having a total of 21 children diagnosed with ADHD. Results: Participants discussed several parenting challenges but advocated for the child by working closely with the child's school and physician. They also managed relationships with family members to protect the child from possible physical or emotional harm. However, parents desired more social support for management of ADHD. Conclusion: African American parents possess key skills and strategies in their management of children with ADHD. Further research is needed to determine the roles and responsibilities of extended family members for children with this disorder, and to identify the social supports parents access to aid with ADHD management.

Bridges to the Doctorate: mentored transition to successful completion of doctoral study for underrepresented minorities in nursing science.

Nursing has a shortage of doctorally-prepared underrepresented minority (URM) scientists/faculty. We describe a five-year University of Illinois at Chicago (UIC) Bridges program for URM master's students' transition to doctoral study and factors in retention/graduation from the PhD program. Four master' students from two partner schools were recruited/appointed per year and assigned UIC faculty advisors. They completed 10 UIC credits during master's study and were mentored by Bridges faculty. Administrative and financial support was provided during transition and doctoral study. Partner schools' faculty formed research dyads with UIC faculty. Seventeen Bridges students were appointed to the Bridges program: 12 were admitted to the UIC PhD program since 2004 and one graduated in 2007. Eight Bridges faculty research dyads published 5 articles and submitted 1 NIH R03 application. Mentored transition from master's through doctoral program completion and administrative/financial support for students were key factors in program success. Faculty research dyads enhanced the research climate in partner schools.

Nurses' attitudes and childbearing adolescents: bridging the cultural chasm.

Childbearing adolescents represent a vulnerable population with documented health disparities. Although nurses have more contact with childbearing adolescents than any other health professional, little is known about nurses' attitudes and how their attitudes influence nursing practice. The relationship of the provider's attitude to the patient has been associated with health outcomes. An exploratory, descriptive study using focus groups of registered nurses from two hospitals within the Chicago area were asked to discuss their perceptions of challenges, barriers and opportunities related to the care of low-income childbearing adolescents. The theme of system-level barriers to care was discussed by most nurses. The most dense area of data, however, centered on cultural conflict and chasm. Many nurses felt that they had not received the skills and knowledge needed to provide care to diverse families. This study illuminated the need for nursing education and practice settings to enhance cultural knowledge and skills.

Health disparities among men from racial and ethnic minority populations.

The purpose of this chapter is to review empirical nursing literature on the health care of racial and ethnic minority men, specifically African American/Black, Hispanic/Latino, American Indian/Alaskan Native, and Asian/Pacific Islander men. CINAHL and MEDLINE computer databases were searched from their earliest online date until 2003 using a combination of manual and computer-based methods to identify the nursing literature with samples that included minority men. Articles were selected according to their relevance to the four areas of adult health disparities targeted by the Department of Health and Human Services (DHHS): heart disease, malignant neoplasms (cancer), diabetes, and HIV/AIDS. A total of 52 empirical articles were selected. Findings were categorized as addressing disease prevention, disease screening, or disease management of the targeted conditions. This review demonstrates that some important work has already been accomplished in nursing research to address the four adult health disparities targeted by DHHS. Future research should be based on gaps identified in existing literature and should be guided by culturally appropriate theories and constructs.

How scholarly nursing literature addresses health disparities for racial/ethnic minority men.

The purpose of this article is to review conceptual/theoretical and review/agenda setting nursing literature on the health care of racial/ethnic minority men [specifically African American/Black, Hispanic/Latino, American Indian/Alaskan Native and Asian/Pacific Islander men] in one of the four targeted areas of health disparities. CINAHL and MEDLINE computer databases were searched from 1983 to the present using a combination of manual and computer-based methods to identify the nursing literature that included any racial/ethnic men in the sample and addressed at least one of the four areas of health disparities targeted by Department of Health and Human Services (DHHS) that affect adults: heart disease, malignant neoplasms (cancer), diabetes mellitus and Human Immunodeficiency Virus (HIV)/AIDS. This review provides an overview of health disparities experienced by racial/ethnic minority men in the targeted areas and of the types of conceptual and agenda-setting articles published in scholarly nursing literature in those targeted areas.

Rapid repeat pregnancy among unmarried, African American adolescent parent couples.

This article describes rapid repeat pregnancy (RRP), getting pregnant or giving birth again within 24 months of giving birth, in a group of unmarried, low-income, African American first-time, adolescent parent couples from the perspectives of their kinship systems, that is, the adolescent parents and their parents or parental figures. RRP has been associated with prematurity, low birth weight, inadequate prenatal care, school dropout, increased potential for poverty, and prolonged welfare dependence. There were 21 RRPs among 24 kinship systems: 9 adolescent males who fathered RRPs with new partners and also reported having been denied access to their study babies; 6 adolescent mothers with new partners, who also reported intimate partner violence with the study adolescent father; and 6 study adolescent parent couples, whose paternal family reported doubts about the paternity of the study babies. Adolescent fathers should be offered the same child care and contraceptive information routinely offered to adolescent mothers.

"You have to hunt for the fruits, the vegetables": environmental barriers and adaptive strategies to acquire food in a low-income African American neighborhood.

This qualitative study sought to understand food acquisition behaviors and environmental factors that influence those behaviors among women in a low-income African American community with limited food resources. We drew on in-depth interviews with 30 women ages 21 to 45 years recruited from a community health center in Chicago, Illinois. Data were analyzed using qualitative content analysis. Emergent themes revealed that women identified multiple environmental barriers--material, economic, and social-interactional--to acquiring food in an acceptable setting. In response, they engaged in several adaptive strategies to manage or alter these challenges, including optimizing, settling, being proactive, and advocating. These findings indicate that efforts to improve neighborhood food environments should address not only food availability and prices but also the physical and social environments of stores.

Interactions between adolescent fathers and health care professionals during pregnancy, labor, and early postpartum.

OBJECTIVE: To examine interactions between adolescent fathers and health care professionals from the perspectives of the families of the adolescent fathers during pregnancy and early postpartum. DESIGN: Content analysis methods were used to analyze data from the prenatal and 1 month data points of a larger longitudinal qualitative case study design examining paternal involvement. A purposive sample of 25 sets of unmarried, low-income Black adolescent fathers, adolescent mothers, and at least one of each of their parents were individually interviewed at 1, 6, 12, 18, and 24 months after birth using a semistructured interview guide. SETTING: Approximately 90% of participants were interviewed in their homes. PARTICIPANTS: Annual household incomes were between 0 dollars to 28K dollars (M=14,661 dollars). The 111 participants included 25 sets of adolescent parents, 50 grandmothers, and 11 grandfathers. Approximately 75% of the adolescent fathers were 17 to 19 years of age. RESULTS: Supportive (information, emotional, and material support), distancing, and neutralizing interactions between health care professionals and adolescent fathers were identified. CONCLUSIONS: Although most interactions were perceived as supportive, distancing, and neutralizing interactions could potentially have negative long-term effects for these vulnerable families and contribute to disparities in health care. Nurses may be important resources for these new fathers.

Family matters: how mothers of adolescent parents experience adolescent pregnancy and parenting.

Family support has been demonstrated to be essential for successful long-term outcomes of low-income, African American adolescent mothers and their children [Apfel, N., & Seitz, V. (1996). Urban girls: Resisting stereotypes, creating identities. NY: New York University Press]. Family support may also be essential for the continued paternal involvement of unmarried, low-income, African American adolescent fathers. Twenty mothers of unmarried, low-income, African American adolescent parents were individually interviewed for this qualitative study to describe the experiences of paternal grandmothers (mothers of adolescent fathers) and maternal grandmothers (mothers of adolescent mothers) during transition to fatherhood for unmarried, low-income, African American adolescent fathers. Findings are presented according to the six factors of transition conditions from the nursing model of transitions [Schumacher, K., & Meleis, A. I. (1994). Image, 26, 119-127]: meanings, expectations, level of knowledge and skill, the environment, level of planning, and emotional and physical well-being. Findings indicate that transition to parenthood and grandparenthood is often abrupt and complicated for unmarried, low-income, African American adolescent parents and their families. Paternal and maternal grandmothers continue to act as primary parents for their adolescents while compensating for the lack of skills and attributes for the adolescents' children. Findings from this study can be used to design developmentally and culturally appropriate health care interventions that can support these families during this complex process.