Early Age of Alcohol Initiation and its Association with Suicidal Behaviors.

OBJECTIVE: The relationship between alcohol use and suicidal behaviors is well-accepted, but less is known about the contribution of its early initiation. This study was designed to test the association of early alcohol initiation versus later initiation with suicidal ideation and attempt in an ethnically diverse sample. METHODS: The Collaborative Psychiatric Epidemiology Surveys (CPES), 2001-2003 (n = 20,013), database was used. A total of 13,867 participants were selected included 56.9% females and 43.1% males. Race and ethnicity were reported as 28.8% non-Hispanic White, 39.1% Black, 20.3% Latino, and 11.9% Asian. Logistic regression analyses tested the associations between early (< =14 years) and later (> =15) age alcohol initiation with suicide ideation and attempts. Alcohol initiation was indexed by self-report of the first time that any alcohol product was consumed. Potential confounders were controlled. RESULTS: Early alcohol initiation was associated with higher odds (AOR = 3.64, 95% CI [2.51, 5.28]) of suicide ideation as compared with adults who had initiated > = age 15 (AOR = 2.11, 95% CI [1.46, 3.04]). Early age initiation was also associated with higher odds (AOR = 3.81, 95% CI [2.02, 7.18]) of lifetime suicide attempt versus later age initiators (AOR = 2.03, 95% CI [1.08, 3.79]). Significant differences were found between early and later age of initiation. Conclusion: Early age of alcohol initiation has profoundly increased odds of suicide ideation or attempt. It is critical that effective prevention programs for children and their caregivers be implemented to prevent or delay alcohol initiation and lessen the risk for future suicidal behaviors.

Online couples mindfulness-based intervention for young breast cancer survivors and their partners: A randomized-control trial.

PURPOSE: Young breast cancer survivors (YBCS) face unique challenges in coping with disease, distress, and relationship concerns. The purposes of this study were to understand the acceptability and feasibility of an online Mindfulness-Based Intervention (MBI) for YBCS and their partners (i.e., Couples Mindfulness-Based Intervention: C-MBI) and to compare the effectiveness of the C-MBI to a closely-matched control, an online MBI for individuals (I-MBI). METHODS: YBCS and their partners were recruited. Couples were randomly assigned to an 8-week C-MBI (couples = 41) or to I-MBI (couples = 36), which included one-hour video modules, a manual, and guided-meditation audios. Both couple members participated in the C-MBI; only the YBCS participated in the control I-MBI. Participants answered surveys about individual- and couple-level functioning at baseline and post-intervention. RESULTS: Online delivery was shown to be feasible and acceptable. For YBCS and their partners, levels of perceived stress, anxiety, depression, and fatigue were lower after the intervention, in both conditions. Unexpectedly, however, participating in the C-MBI appeared to have detrimental effects on dyadic adjustment and relationship quality. CONCLUSION: Although YBCS and their partners reported online delivery was acceptable and benefited well-being, for couple-based MBIs to have benefits for relationship functioning, it may be necessary for couples to have the support of other couples and an instructor. Online delivery may be particularly acceptable and effective for clinical populations, including YBCS. Medical professionals may be more likely to recommend online-MBI programs to cancer survivors, because the programs are of little or no cost.

Pilot Study of the Mastery Lifestyle Intervention.

BACKGROUND: Recognizing the effects of acculturation on quality of life and emotional health, especially during pregnancy, we developed an intervention that would target these factors in order to improve maternal well-being during the prenatal period and potentially improve infant outcomes, particularly preterm birth for Mexican-American women (Latinas). OBJECTIVE: The purpose of these pilot studies was to test the acceptability, feasibility, and preliminary efficacy of the mastery lifestyle intervention (MLI) to decrease depressive and anxiety symptoms and improve coping as implemented in prenatal clinics with culturally homogenous groups of Latinas. METHODS: The MLI was tested in three small pilot studies (n = 15), one in El Paso, Texas (an urban area), and two in Bastrop, Texas (a rural area outside Austin), for acceptability and feasibility. A pretest/posttest, quasi-experimental design was used with pregnant self-identified Mexican-American Latinas at 14-20 weeks' gestation. Measures of anxiety, depressive symptoms, and positive and negative coping were used. RESULTS: Feasibility was a success in terms of implementation of the MLI in an active prenatal clinic setting and the use of electronic tablets for data collection and entry of data into REDcap. Satisfaction was high, with the location of the MLI being at their primary OB/GYN clinic. Participants reported that six intervention sessions appear to be ideal as was the class length of 1.5 to 2 hours. On Cohen's d, there were medium to large effect size decreases in depressive and anxiety symptoms and small to medium effect size decreases in the use of negative coping strategies and small effect sizes for increases in positive coping strategies. DISCUSSION: Pilot testing of the MLI indicated that it was well accepted from the participants and feasible as a culturally tailored behavioral therapy administered in a group setting by nurse practitioners. Our initial pilot results also suggest preliminary efficacy as indicated by moderate to large Cohen's d effect sizes for depression and anxiety.

Being African-American, Obese, Female, and Residing in an Urban Area: The Lived Experience.

The objective of this qualitative study was to explore the experience of being African-American, obese, female, and residing in an urban area. Critical Social Theory of Black Feminist Thought guided the study framework and study questions. Within this framework, African-American women are multidimensional human beings with attitudes, habits, and personalities influenced by their religious beliefs, family, school, friends, and racial history. Interview data were obtained from 10 women and analyzed using qualitative techniques. These individuals were aware of health consequences related to obesity and described barriers that inhibit healthy choices. Participant level of education provided the ability to avoid negative physical and social consequences associated with obesity.

An Integrative Review on Standardized Exams as a Predictive Admission Criterion for RN Programs.

Nursing programs reject qualified applicants due to limited clinical placements and faculty. By admitting the strongest candidates, schools of nursing will reduce attrition rates, increase NCLEX-RN pass rates, and speed the entry into practice of well-prepared nurses to help stem the nursing shortage. This integrative review identified the standardized admission exams most predictive of student success. Included were articles published between 2005 and 2016 that focused on admission criteria, RN programs, specific exams (e. g., HESI-A2, TEAS, SAT, CAAP, or ACT), NCLEX-RN performance, or program success. Standardized exams are effective predictors of success in programs of nursing and first-attempt NCLEX-RN. While predictive accuracy differs between exams, findings suggest that the HESI-A2 is currently the best predictor of success. By optimizing the use of standardized exams as admission criteria, nursing programs can reduce attrition rates and improve NCLEX-RN pass rates. This will maximize program capacity and contribute to a greater number of practicing nurses.

Comparison and evaluation of dietary quality between older and younger Mexican-American women.

OBJECTIVE: To compare and evaluate the dietary quality of young and older sedentary Mexican-American women. Understanding key dietary concerns, while considering developmental transition periods and cultural relevance, can provide insight for developing appropriate nutrition interventions. DESIGN: Cross-sectional dietary data were collected using unannounced 24 h diet recalls to assess nutrient intake adequacy (Estimated Average Requirement cut-point method) and dietary quality (Healthy Eating Index (HEI) 2010). SETTING: Mujeres en Acción and Madres para la Salud, two community-based physical activity interventions. SUBJECTS: Participants were 139 young (28 (sd 6) years) and 124 older (55 (sd 7) years) overweight/obese sedentary Mexican-American women (BMI=25·0-35·0 kg/m2) of low socio-economic status. RESULTS: Older women consumed less Ca, Fe, folate, empty calories and energy from carbohydrate, but more fruit, vegetables, greens and beans, and fibre than younger women (all P<0·05). Over 60 % of all participants had an intake below recommendations for fibre, Ca, vitamin E, vitamin C and folate. Both groups had low total HEI-2010 scores (62 for older and 63 for younger women; NS), with 57 % of older and 48 % of younger women classified as having a poor diet. CONCLUSIONS: Despite differences in nutrient requirements according to developmental transition periods (childbearing v. perimenopausal), overall, older and younger Mexican-American women generally had low-quality diets and may benefit from dietary quality improvement.

Correlates of depressive symptoms after birth for Latinas who are overweight or obese.

Depression symptoms and overweight/obesity are common concerns during childbearing. Both conditions are associated with poor outcomes at birth and can have long-lasting consequences. Predictors of depressive symptoms among overweight and obese low-income and ethnically diverse women are not known. Data are from the Madres para la Salud trial with 139 postpartum Latinas. Depressive symptoms during a prior pregnancy were positively related, while social support and moderate intensity physical activity (PA) were negatively related to depressive symptoms after birth. Social support and PA may be effective interventions, particularly for women who have experienced depressive symptoms in a prior pregnancy.

Social marketing: approach to cultural and contextual relevance in a community-based physical activity intervention.

We report the social marketing strategies used for the design, recruitment and retention of participants in a community-based physical activity (PA) intervention, Madres para la Salud (Mothers for Health). The study example used to illustrate the use of social marketing is a 48-week prescribed walking program, Madres para la Salud (Mothers for Health), which tests a social support intervention to explore the effectiveness of a culturally specific program using 'bouts' of PA to effect the changes in body fat, fat tissue inflammation and postpartum depression symptoms in sedentary Hispanic women. Using the guidelines from the National Benchmark Criteria, we developed intervention, recruitment and retention strategies that reflect efforts to draw on community values, traditions and customs in intervention design, through partnership with community members. Most of the women enrolled in Madres para la Salud were born in Mexico, largely never or unemployed and resided among the highest crime neighborhoods with poor access to resources. We developed recruitment and retention strategies that characterized social marketing strategies that employed a culturally relevant, consumer driven and problem-specific design. Cost and benefit of program participation, consumer-derived motivation and segmentation strategies considered the development transition of the young Latinas as well as cultural and neighborhood barriers that impacted retention are described.

Promotoras' roles in integrative validity and treatment fidelity efforts in randomized controlled trials.

Promotoras from the communities in which interventions are implemented can be effective contributors to validity and fidelity efforts. This article describes a 48-week randomized controlled trial Madres para la Salud (Mothers for Health) and illustrates the use of promotoras as collaborative members of the research team to contribute to attaining integrative validity and treatment fidelity. Madres para la Salud implements a culturally tailored physical activity program to effect changes in body fat, systemic and fat tissue inflammation, and depression symptoms. The significance of Madres para la Salud treatment validity and fidelity processes includes cultural tailoring of a social support intervention, and a promotora model to incorporate initial and ongoing fidelity monitoring.

Early Age of Cannabis Initiation and Its Association With Suicidal Behaviors.

Background: Suicide rates in the U.S. have continued to rise over the last 2 decades. The increased availability and broader legalization of cannabis is a public health concern, particularly among adolescents. The objective of this study was to examine the association between the age of cannabis initiation and lifetime suicidal ideations and attempts in a sample of adults aged 18 or older. Methods: Data are from the Collaborative Psychiatric Epidemiology Surveys (CPES), 2001 to 2003 (N = 15 238). The primary objective of the CPES was to collect data about the prevalence of mental disorders, impairments associated with these disorders, and their treatment patterns from representative samples of majority and minority adult populations in the U.S. Logistic regression analyses were conducted to test the association between cannabis initiation age (early ⩽14 years old; later >14 years old) and outcomes of lifetime suicide ideation and attempts. Cigarette use, cannabis use, gender, income, race, education, and age were controlled for the analyses. Results: Overall, 12.5% of participants reported suicide ideation, while 4.2% reported attempt. Early cannabis use was associated with a higher risk of suicide ideation (AOR = 3.32, 95% CI [2.75, 3.80]) than later cannabis use (AOR = 2.15, 95% CI [1.92, 2.39]). Early cannabis use was associated with a higher risk of suicide attempt (AOR = 4.38, 95% CI [3.48, 5.52]) than later cannabis use (AOR = 2.56, 95% CI [2.14, 3.06]). Wald chi-squared tests revealed significant differences between the early and late initiation for both ideation (χ2 = 26.99; P < .001) and attempts (χ2 = 26.02; P < .001). Conclusions: Significant associations were found between early initiation of cannabis and suicide behaviors. As suicide rates continue to rise, it is recommended that clinicians, treatment providers, and other professionals consider the use of cannabis at an early age as a risk for subsequent suicide behaviors.

The association between experiencing police arrest and suicide ideation among emerging young adults: Does race matter?

The objective of the study was to examine the association between lifetime arrest and marijuana-related first arrest with past-year suicide ideation among Black and White people. We used data from Wave-IV (2008-2009; N = 5114) of the publicly available National Adolescent Health Study (Add Health) data. A total of 4313 Non-Hispanic Black and White participants were selected for this study. Logistic regression was used to assess whether lifetime arrest and marijuana-related arrests were associated with past year suicide. Overall, 28.8% of the sample reported lifetime arrest, 6.3% reported lifetime suicide ideation, and 3.7% reported marijuana-related arrest. A significantly higher percentage of Black people (32.3%) in comparison to White people (27.4%) reported lifetime arrest (χ2 = 9.91; p < 0.001; df = 1). Among Black people, lifetime arrest (AOR = 2.98; 95% CI, 1.66-5.35; p < 0.001) and marijuana-related arrest (AOR = 4.09; 95% CI, 1.47-11.35; p < 0.001) were both associated with lifetime suicide ideation. Given the rate of death by suicide among Black people has been rising for two decades, further efforts are needed to educate and inform key stakeholders including law enforcement and policymakers regarding racial disparities in arrests, which may contribute to reducing risk for death by suicide among Black people.

Pregnant Mexican American Biopsychosocial/Cultural risks for adverse infant outcomes.

AIMS: To test a model of psychosocial/cultural/biological risk factors for poor birth outcomes in Latina pregnant women. DESIGN: An observational study measuring acculturation, progesterone, cortisol, cotinine, age, marital status, income, stress, depressive symptoms and coping. We tested a structural equation model to predict risk. METHODS: We obtained a convenience sample (N = 515) of low medical risk pregnant Mexican American Hispanic women at 22-24 weeks of gestation. Bilingual research nurses collected data from blood, urine and questionnaires. Self-report measures were the Beck Depression Inventory-II, the Perceived Stress Scale, the Acculturation Rating Scale for Mexican Americans-II and the Brief Cope. We measured progesterone and cortisol in plasma and cotinine levels in urine by enzyme-linked immunoassays. RESULTS: A PLS-SEM model revealed that Mexican American Hispanic pregnant women who were younger, single, lower income, more acculturated and who had greater negative coping, stress and depression were most at risk for having earlier and smaller babies.

Conceptual Model for Predicting Academic Success in Prelicensure Nursing Programs Through Expanded Cognitive Aptitude Assessment.

BACKGROUND: Attrition from prelicensure nursing programs is a serious issue with implications for students, nursing programs, and the nursing workforce. Academic failure due to insufficient cognitive aptitude often contributes to this problematic attrition rate. Thus, cognitive aptitude could be included in admission criteria, as a predictor of academic success and a strategy to minimize attrition. PROBLEM: Currently, admissions practices are often incomplete and lack standardization for measuring cognitive aptitude. APPROACH: The Nursing Cognitive Aptitude Model (NCAM) presented in this article is an innovative conceptual model to guide educators in expanding current admissions processes. CONCLUSION: The NCAM model depicts the cognitive domains involved in student academic success including current scholastic knowledge, previous academic performance, and critical-thinking ability. Together, these three domains predict student academic success and are a useful reference for the admissions process.

Interventions for weight management in postpartum women.

OBJECTIVE: To report the results of a comprehensive review of published intervention studies to identify the best evidence available for guiding weight management interventions in postpartum women. DATA SOURCES: Electronic searches were conducted of three electronic databases: Cumulative Index to Nursing and Allied Health Literature; Medline; and the Science Citation Index, Expanded, in the Web of Science from 1994 to May 2007. Keyword searches were conducted using the terms obesity, obese, overweight, postpartum, pregnancy weight, and weight management in postpartum women. STUDY SELECTION: Six studies were selected that met the inclusion criteria of testing interventions and one that reported preintervention planning and targeted a weight management intervention for postpartum women. DATA EXTRACTION: All six interventions showed significant impact with diet and exercise or some combination on body composition in the targeted sample of women. DATA SYNTHESIS: The strengths of previous studies include an emphasis on precision in outcome measures and experimental conditions; limitations were that the theoretical basis for the interventions was frequently omitted and limited attention given to the cultural, social, and contextual factors established in descriptive research. CONCLUSIONS: Interventions need to target women early in their childbearing years to have the most significant long-term impact.

Today's challenge, tomorrow's excellence: the practice of evidence-based education.

Nurse educators are being challenged to maintain quality in light of increasing numbers of students, declining numbers of experienced faculty, societal mandates, and rapid changes in health care. The scholarship underlying the practice of nursing education, or evidence-based education, must continue to be explored through the design, testing, and refinement of education strategies from nursing and other disciplines. The involvement of every educator in this process will help create institutional valuing that serves to retain inquisitive and reflective educators in academic settings, while expanding evidence-based education in nursing. This article describes a literature review of the scholarship of nursing education practice and suggests approaches to generate a dynamic explosion of growth in nursing education to inform our students, promote optimal client health outcomes, and challenge each of us to reach higher levels of excellence in the practice of nursing education.

Overweight and obesity in postpartum Hispanic women.

Overweight and obesity vary in prevalence among particular groups, and are especially problematic for childbearing Hispanic women. The complex interaction between physical changes associated with pregnancy, role changes accompanying birth, and family and cultural values related to childbearing are superimposed upon the underlying mechanisms that create or perpetuate obesity. In this article we review biological and behavioral research on obesity in postpartum Hispanic women to identify critical components for intervention studies focused on weight management. Recommendations are offered for health care providers and researchers.

Psychosocial correlates of depression symptoms during the third trimester of pregnancy.

OBJECTIVE: To explore the psychosocial correlates of depression symptoms during the third trimester of pregnancy. DESIGN: Cross-sectional design guided by Selye's theory of stress. SETTING: Prenatal care provider offices or mutually agreeable locations in the Pacific Northwest. PARTICIPANTS: One hundred thirty-nine women in their third trimester of pregnancy. The majority was Caucasian and married. Fifty-two of the participants (38%) had scores greater than or equal to 16 on the Centers for Epidemiologic Studies Depressed Mood Scale. MAIN OUTCOME MEASURE: The Centers for Epidemiologic Studies Depressed Mood Scale. RESULTS: Stepwise linear regression indicated that 46% of the variance of third-trimester depressive symptoms was due to brief and intermittent negative mood states that occurred primarily during the first trimester, a lack of marital satisfaction and social support, and gravida. Lifetime abuse did not contribute significantly to third-trimester depression symptoms. CONCLUSIONS: One third of the sample reported subclinical levels of depression symptoms. Prenatal care providers may want to consider these minor and brief mood changes as predictive of depression symptoms later in pregnancy, particularly when experienced during the first trimester.

Psychometric assessment of the Postpartum Depression Predictors Inventory-Revised.

Identification of women at risk for postpartum depression requires reliable and valid assessment indices. The purpose of this article is to describe the psychometric properties of the Postpartum Depression Predictors Inventory-Revised (PDPI-R). Psychometric assessment of the PDPI-R was conducted in conjunction with the Centers for Epidemiologic Studies Depressed Mood Scale, and the Edinburgh Postnatal Depression Scale, using data from 139 pregnant women who were followed for 8 months after birth. The prenatal PDPI-R demonstrated concept, concurrent, and predictive validity. The postpartum PDPI-R demonstrated concurrent validity. Factor analysis revealed four underlying factors that did not match the original conceptualization of the instrument. Reliability of the total score resulting from the factor analysis was .83. Initial support for the reliability and validity of the PDPI-R was indicated.

Design and testing of classroom and clinical teaching evaluation tools for nursing education.

Student evaluations of teaching provide administrators an overall picture of the effectiveness of personnel and contribute data for promotion and merit decisions. These evaluations must be assessed for their relevance, validity, and reliability. This paper describes the development process and psychometric testing for clinical (n = 149) and didactic (n = 148) student evaluation of teaching forms for undergraduate and graduate courses in one college of nursing. Validity and reliability results were quite strong for the instruments, both of which evidenced a one-factor solution with factor loadings ranging from .68-.88 and Cronbach's alphas of .96 (Classroom) and .95 (Clinical). The clinical and classroom evaluation tools are relatively short, decreasing the burden on students who need to complete the instruments for multiple instructors in any one semester. Initial testing of the psychometric properties of the tools supports their continued use in colleges of nursing.