Look at my pearly white teeth: Exploring adolescents' oral health behavior.

Informed by grounded theory, this study explored adolescent oral health behaviors to determine what factors influence them and to develop a substantive theory explaining the social process behind the behaviors identified. Multiple types of data were collected and analyzed simultaneously: demographic and oral health questionnaires, 16 individual interviews, eight small group discussions, field notes, and investigator memoing. Participants were 37 Midwestern adolescents aged 13-18, and most were White or African-American females 14 years of age whose parents had at least a high school education. While more than half reported using mouthwash and brushing their teeth regularly, almost all participants described their behavior in terms of relationships, confidence, and attractiveness rather than health. Top motivators were habits learned as children and the desire to be attractive or "kissable." To reflect teens' understanding of "healthy" as good-looking, and their primary concern not with having healthy teeth but with being attractive to peers, our model of the basic social process of adolescent oral health behavior is called "Look at my Pearly White Teeth." Understanding the actual motivations behind adolescent oral health behavior can help public health administrators develop more effective interventions, especially for teens who did not learn healthy habits as children.

Methodological Issues of Research with African-American Women: Influences on Long-Term Physical Activity in Physically Active African-American Women.

This paper reports the methodological challenges encountered while performing a descriptive, qualitative study examining the perspectives of African-American women who successfully maintained long-term physical activity. The socioecological model was used to expand on the dynamics pertaining to the long-term physical activity of 14 African-American women between 35 and 65 years of age. These women were recruited in 2 Midwestern American states and had been physically active for more than 6 months at the time of the study. Content analysis of themes revealed factors influencing physical activity at the individual, social, environmental, and political levels. Methodological challenges the student researcher encountered were choosing the appropriate framework to guide the study, recruiting participants who met the inclusion criteria, and proficiently transcribing and organizing the responses for data analysis using qualitative analysis software. The reflections described in this paper may provide insight to challenges and possible solutions for new researchers to consider when developing a research project.

Parental Consent and Access to Oral Health Care for Adolescents.

While most states allow minors 12 years and older to consent to services for contraception, prenatal care, or sexually transmitted infections, the same adolescents are required to have parental consent for even preventive oral health care. Many adolescents are denied access to preventive oral health care because of the challenge of securing parental consent for care when parents are unwilling, unable, or unavailable to consent. Our purpose is to examine the barriers to preventive oral health care for U.S. adolescents related to parental consent laws, explore the issues surrounding these laws, and recommend policy changes. We explain the current range and status of consent laws across the country and arguments for parental consent law as it now stands. We discuss the difficulty of applying general medical consent law to preventive oral health care, neuroscience research on cognitive capacity among adolescents, and the distinction between parental consent and adolescent assent. We recommend replacing required "opt-in" consent with simpler "opt-out" consent; developing a tool for assessing adolescent decision-making capacity; advocating for consent laws that apply specifically to preventive oral health care; and empowering school nurses to lead local, state, and nationwide policy and legislation efforts.

Reliability and validity of the Treatment Satisfaction Questionnaire for Medication among Portuguese-speaking Brazilian patients with hypertension.

AIMS AND OBJECTIVES: This study examined the reliability and validity of the Brazilian Portuguese version of the Treatment Satisfaction Questionnaire for Medication (version 1.4) among patients with hypertension. Understanding the patient experience with treatment satisfaction will contribute to improved medication adherence and control of hypertension. BACKGROUND: Hypertension is a serious problem in Brazil that is associated with chronic illness controlled, in part, by consistent adherence to medications. Patient satisfaction with medication treatment is associated with adherence to medication. The Treatment Satisfaction Questionnaire for Medication (version 1.4) is a promising instrument for measuring medication; however, to date there has been no report of the reliability and validity of the instrument with Portuguese-speaking adults with hypertension in Brazil. DESIGN: Cross-sectional descriptive exploratory study. METHODS: A convenience sample of 300 patients with hypertension in an outpatient setting in the southeast region of São Paulo state in Brazil completed the Treatment Satisfaction Questionnaire for Medication (version 1.4). The instrument, comprised of four subscales, was evaluated for reliability using correlation analyses and internal consistency. Confirmatory factor analysis was used to determine factorial validity. RESULTS: Correlational analyses, internal consistency (Cronbach's alpha) and hierarchical confirmatory factor analysis demonstrate adequate support for the four-factor dimensionality, reliability and factorial validity of the Treatment Satisfaction Questionnaire for Medication (version 1.4). CONCLUSIONS: This study provides modest evidence for internal consistency and factorial validity of the Treatment Satisfaction Questionnaire for Medication (version 1.4) in Portuguese-speaking adult Brazilians with hypertension. Future testing should focus on extending reliability testing, discriminant validity and potential translation and literacy issues in this population. RELEVANCE TO CLINICAL PRACTICE: Within known limitations, clinicians will find the Treatment Satisfaction Questionnaire for Medication (version 1.4) useful for identifying adult Portuguese-speaking Brazilian patients at risk of poor adherence and tailoring adherence interventions to promote hypertension control.

A systematic review of oral health behavior research in american adolescents.

Despite improvements in prevention, oral diseases are a problem among adolescents, linked to poor health outcomes and poor school performance. Little is known about adolescent oral health behavior. This systematic review describes factors that influence oral health behavior in adolescents. Inclusion criteria for the literature search were American children aged 12-19 and research on oral health behavior. Articles (n = 353) were retrieved, eight met the inclusion criteria, and of these, six were descriptive and two were experimental studies. The matrix method, critical appraisal, and content analysis produced themes across the studies. Participants were primarily African Americans and Hispanics of both genders, of lower socioeconomic status, aged 12-19. Findings suggest that ethnicity, race, and gender may influence oral health behavior in adolescents and that interventions have an effect. Research is needed to explore what other factors may influence oral health behavior in adolescents, long-term health outcomes, and school performance.

A qualitative study of man-sharing and the implications for midlife African American women's risk for HIV infection.

Midlife African American women are at risk for HIV related to higher prevalence of infection among African Americans and concurrent sexual partnerships. In this grounded theory study, we explored the context of decision making related to concurrent sexual partnerships among 36 African American women between the ages of 40 and 65 years. Qualitative data from semi-structured interview and focus group schedules collected between fall 2003 and summer 2006 are the basis for analysis. Transcripts were analyzed using constant comparison to develop concrete and abstract categories, and member checking used to verify findings. Women reported that partner concurrency and competition for acceptable men partners, "Man-Sharing," among midlife African American women influenced sexual decision-making, potentially resulting in greater risk for HIV infection. Future research focusing on the power differential in heterosexual relationships, inter-racial dating, and limiting the risks associated with partner concurrency may be fruitful.

An Integrative Review Examining Student-to-Student Incivility and Effective Strategies to Address Incivility in Nursing Education.

BACKGROUND: Incivility is a low-intensity, discourteous behavior intended to disrupt or harm positive interaction. If allowed, student-to-student incivility can undermine the educational environment. PURPOSE: The purpose of the integrative review was to examine factors influencing incivility among nursing students and teaching strategies used to reduce incivility in nursing education. METHODS: Qualitative and quantitative studies were reviewed. The Johns Hopkins Research Evidence Appraisal tool was used to narrow down the selection of articles. Content analysis was used to evaluate the qualitative research. RESULTS: Five major points of interest were identified: workload and high expectations contributed to incivility, degrees of incivility, effects of incivility, coping mechanisms among individuals, and effective teaching strategies addressing incivility. CONCLUSION: Continued research on innovative teaching strategies that raise awareness of civility while reducing incivility is warranted.

A qualitative study of influences on long-term physical activity in physically active African American women.

Performing routine physical activity (PA) is one of several measures that may be taken to prevent chronic illness; however, African American (AA) women are among the least physically active groups in the United States. The purpose of this study was to gain perspectives of AA women who are physically active and understand how they continue long-term PA. In this qualitative descriptive study, we interviewed 14 AA women using researcher-developed open-ended questions. Transcription was analyzed through content analysis. The socioecological model guided the organization of themes that emerged from the data. Individual level themes were: managing my health and lifestyle to remain physically active. Social level themes were: incorporating PA in social exchanges with family, friends, and coworkers and establishing mutual support of PA among family and friends. Environmental level themes were: using the neighborhood and work environments as venues encouraging PA. There were no emerging themes at the political level; however, there were findings at the environmental level that could be interpreted as policy-level issues. Knowing specific factors that influence long-term PA may help us with the development of interventions to increase PA in AA women.

Motivation and exercise in rural postmenopausal women: A literature review.

PURPOSE: Most rural Americans are not meeting recommended guidelines for physical activity (PA); rural postmenopausal women (RPMW) have the highest inactivity rates. Self-Determination Theory, a motivational theory which examines the effects of qualitatively different types of motivation is used to conceptualize how RPMW make decisions regarding PA. The purpose of this review is to examine published literature related to motivation and exercise or PA in RPMW. The research questions include (a) what is known about the relationship of motivation to exercise in RPMW; and (b) how have motivation and exercise been measured in RPMW? METHODS: An electronic database search resulted in a sample of 251 articles, with an additional 9 articles acquired by scanning reference lists. Search terms included motivation, exercise, rural women, urban women, and PA. Criteria for inclusion were postmenopausal women, primary research published before 2019, reported in English, and taking place in the United States. FINDINGS: Thirteen articles involving RPMW were included. The sample contained four qualitative, eight quantitative, and one mixed-method studies. There is little research regarding motivation and PA in RPMW. Barriers and facilitators to PA have been measured. Motivation was mentioned in two studies but not measured. PA is most often measured with self-report questionnaires. CONCLUSION: The decision to be active or sedentary is embedded in motivation. Additional research that objectively measures both motivation and PA in a consistent manner is required to provide a knowledge base regarding motivation and PA behavior in RPMW.

Midlife African-American women's protective and risky practices related to HIV.

AIM: This paper is a report of a study exploring the relationships between social, cultural and individual factors and midlife African-American women's risk taking and protective practices related to HIV/AIDS. BACKGROUND: The extent of the HIV epidemic among women of African descent around the world is difficult to discern, but women of color are disproportionately affected. While the risk factors for HIV infection are clearly defined, the context for sexual risk-taking and protective practices is poorly understood for midlife African-American women. METHOD: The study was guided by grounded theory methods. The Afrocentric Paradigm, Theory of Gender and Power, and Social Cognitive Theory formed the basis for developing semi-structured interview and focus group schedules. Theoretical sampling and principles of emergent design were used to guide data collection and analysis. Interview and focus group data were collected between 2003 and 2006. Transcripts were analyzed using constant comparison to develop descriptive themes, and member checking was used to verify findings. FINDINGS: African-American women (n = 36) who were between the ages of 40 and 64 years and HIV negative volunteered for the study. Participants characterized their sexual decision-making as two conflicting processes -'Taking Responsibility' and 'Getting Caught Up'- related to being accountable for sexual decision-making and having strong sexual desires. CONCLUSION: Stereotypical views of midlife African-American women must be overcome to ensure that they are treated appropriately in the clinical setting. Increasing emphasis on developing woman-controlled HIV prevention approaches holds the greatest hope for controlling the epidemic among women.

Older people's use of non-pharmacological interventions for chronic, non-cancer pain and comfort.

BACKGROUND: Many older people experience chronic pain, so increased comfort and pain relief are important for older residents in assisted and/or supported-living environments. While several studies have found that people using non-pharmacological interventions without taking pain medication experienced significant differences in pain, the effect of non-pharmacological interventions on comfort and chronic pain in older people has not been studied. AIM: To assess differences in comfort and pain among older people in assisted and supported-living facilities who had chronic, non-cancer pain and who used or did not use non-pharmacological interventions. METHOD: A descriptive, comparative, cross-sectional pilot study with a convenience sample of 82 participants from 11 assisted and supported-living facilities. Three questionnaires were used to obtain data on the independent variable of use/non-use of non-pharmacological interventions and the dependent variables of perceived comfort and pain. Multivariate analyses of variance were computed to measure differences between the use/non-use groups, and Roy-Bargmann stepdown analyses were computed to further subdivide and analyse the groups who were using and not using pain medication. RESULTS: No significant differences were found in chronic pain and perceived comfort between participants who did or did not use non-pharmacological interventions if they were not also taking pain medication. However, when participants were also taking pain medication, chronic pain and perceived comfort scores were significantly affected by the use of non-pharmacological interventions. The most common non-pharmacological interventions were exercise, heat therapy, spiritual activity/religion and listening to music. CONCLUSION: Older people using non-pharmacological interventions and taking pain medication had higher perceived comfort scores and lower pain scores than those using pain medication only. Relationships between non-pharmacological interventions and comfort should be explored further. With minor changes, this pilot study design could be used with a larger sample.

African American women's experience of infection with HIV in the rural southeastern United States.

The design of effective behavioral interventions to prevent HIV infection among African American women requires a more complete understanding of the context and circumstances that precipitate infection with the virus. A descriptive study was designed to explore African American women's experiences of infection with HIV in the rural southeastern United States. Ten women living with HIV participated in interviews. All were infected through sex with a man or men; three had engaged in high-risk activities associated with HIV infection including sex trading; seven described themselves as at low risk for infection related to serial monogamy, no injection drug use, and no history of addiction. Participants reported that desire for intimacy coupled with inaccurate risk appraisal of sex partners contributed to their infection. These results provide insight into the role of intimacy in sexual risk taking. Inquiry into how women can be assisted to protect themselves in the context of intimate relationships may improve interventions to prevent HIV.

Nonpharmacological interventions for persistent, noncancer pain in elders residing in long-term care facilities: An integrative review of the literature.

Elders residing in long-term care facilities experience ongoing moderate to severe pain, relief from and increased comfort remain relevant healthcare concerns. However, persistent, noncancer pain may not have been properly addressed due to insufficient attention to research that exists to support the utilization and efficacy of nonpharmacological intervention(s) for elders in long-term care facilities. Our aim of this integrated review was to evaluate the current state of the science on nonpharmacological intervention(s) for pain that are currently utilized in elders who reside in long-term care facilities. Exercise, massage, heat therapy, and relaxation/rest were identified as significant nonpharmacological interventions for persistent pain in elder residents living in long-term care facilities.

Pilot test results of an HIV prevention intervention for high-risk women.

Minority women, incarcerated women, and women using drugs or engaged in survival sex are most vulnerable to HIV. This pilot study was designed to estimate efficacy of an intervention, Women First!, to help these women correctly and consistently use male condoms. Women (N = 74) were recruited from jails, substance-abuse treatment centers, and public health clinics, and enrolled in a randomized controlled trial with an attention-only comparison group. The intervention, based on social cognitive theory and the theory of gender and power and awakening, was delivered over 6 weeks; unprotected vaginal intercourse and correct condom use were measured before and after the intervention. Changes on the dependent variables did not rise to statistical significance due to low power, but descriptive statistics and the multivariate partial η(2) effect size estimate of 0.27 suggest that Women First! is a promising intervention. Future research will require improvements in recruitment, retention, and measurement.

HIV/AIDS among midlife African American women: an integrated review of literature.

HIV occurs among African American women at rates exceeding those among White women, and the prevalence of HIV/AIDS is rising disproportionately among African American adults over 40. The literature between 1987 and 2003 was reviewed for data on prevention and risk taking behavior regarding HIV transmission among midlife African American women. A search of relevant databases revealed four reports specifically targeting African American women aged 40-65. Five reports including this population also included men and other ethnic/racial groups. Content analysis revealed that factors related to risk for HIV included socioeconomic factors, knowledge, perceived vulnerability, sexual assertiveness, and risk taking behavior. Findings suggest that further research on the relationships between sociocultural variables and individual factors may explain prevention and risk taking behaviors in midlife African American women.

Reciprocity and retaining African-American women with HIV in research.

Retaining African-American women who are human immunodeficiency virus (HIV) positive in longitudinal research is crucial to improving prevention and treatment in this population. Interviews with 22 African-American HIV-positive women conducted at the end of a 2-year study indicated that over the course of the study, reports of discomfort with participation gave way to reports of appreciating the benefits of participation. Women commented on the importance of their relationships with researchers, in which they received benefits and provided a service to the researchers. We postulate that developing reciprocity between research teams and participants may be helpful in retaining African-American women in research.