Aligning Organizational Culture and Infrastructure to Support Evidence-Based Practice.

Standardized nursing practice based on the foundations of evidence-based practice leads to high-quality patient care and optimal outcomes. Despite knowing the benefits of evidence-based practice, health care organizations do not consistently make it the standard of care; thus, implementation of evidence-based practice at the system level continues to be challenging. This article describes the process adopted by a facility in the Southwest that took on the challenge of changing the organizational culture to incorporate evidence-based practice. The organization met the challenges by identifying perceived and actual barriers to successful implementation of evidence-based practice. The lack of standardized practice was addressed by developing a group of stakeholders including organizational leaders, clinical experts, and bedside providers. Changing the culture required a comprehensive process of document selection and development, education, and outcome evaluation. The ultimate aim was to implement an integrated system to develop practices and documents based on the best evidence to support patient outcomes.

Do depressive symptoms in male and female adolescents predict unintended births in emerging adulthood?

Unintended birth and mental health are major public health problems in the United States. To date, little research has examined the relationship between depressive symptoms and unintended births, and no research has examined this relationship among men. Data from the National Longitudinal Survey of Adolescent Health (N = 14,271) were used to examine the relationship between depressive symptoms among females and males in adolescence and unintended first birth in emerging adulthood. Respondents who reported higher levels of depressive symptoms in adolescence were more likely to report an unintended birth (OR 1.93, p < 0.001) compared with respondents who did not have children. They were also more likely to report an unintended birth compared with respondents who had an intended birth (OR 1.28, p < 0.05). The relationship between adolescent depressive symptoms and unintended birth remained significant, controlling for background variables, and it did not differ by gender. Adolescent depressive symptoms are associated with unintended birth in emerging adulthood. Thus, policies designed to treat depressive symptoms in adolescence may be effective in reducing unintended pregnancy among young adults.

Is the gene-environment interaction paradigm relevant to genome-wide studies? The case of education and body mass index.

This study uses data from the Framingham Heart Study to examine the relevance of the gene-environment interaction paradigm for genome-wide association studies (GWAS). We use completed college education as our environmental measure and estimate the interactive effect of genotype and education on body mass index (BMI) using 260,402 single-nucleotide polymorphisms (SNPs). Our results highlight the sensitivity of parameter estimates obtained from GWAS models and the difficulty of framing genome-wide results using the existing gene-environment interaction typology. We argue that SNP-environment interactions across the human genome are not likely to provide consistent evidence regarding genetic influences on health that differ by environment. Nevertheless, genome-wide data contain rich information about individual respondents, and we demonstrate the utility of this type of data. We highlight the fact that GWAS is just one use of genome-wide data, and we encourage demographers to develop methods that incorporate this vast amount of information from respondents into their analyses.

Consequences of Teen Parents' Child Care Arrangements for Mothers and Children.

Using the nationally representative Early Childhood Longitudinal Study-Birth Cohort (2001 - 2006; N ≈ 7900), we examined child care arrangements among teen parents from birth through prekindergarten. Four latent classes of child care arrangements at 9, 24, and 52 months emerged: "parental care," "center care," "paid home-based care," and "free kin-based care." Disadvantaged teen-parent families were overrepresented in the "parental care" class, which was negatively associated with children's preschool reading, math, and behavior scores and mothers' socioeconomic and fertility outcomes compared to some nonparental care classes. Nonparental care did not predict any negative maternal or child outcomes, and different care arrangements had different benefits for mothers and children. Time spent in nonparental care and improved maternal outcomes contributed to children's increased scores across domains. Child care classes predicted maternal outcomes similarly in teen-parent and nonteen-parent families, but the "parental care" class predicted some disproportionately negative child outcomes for teen-parent families.

Population composition, public policy, and the genetics of smoking.

In this article, we explore the effect of public policy on the extent to which genes influence smoking desistance. Using a sample of adult twins (n(mz) = 363, n(dz) = 233) from a large population registry, we estimate Cox proportional hazards models that describe similarity in the timing of smoking desistance among adult twin pairs. We show that identical twin pairs are significantly more likely to quit smoking within a similar time frame compared with fraternal twin pairs. Importantly, we then show that genetic factors for smoking desistance increase in importance following restrictive legislation on smoking behaviors that occurred in the early and mid-1970s. These findings support the social push perspective and make important contributions to the social demography and genetic epidemiology of smoking as well as to the gene-environment interaction literatures.

Trends in the genetic influences on smoking.

Using twin pairs from the National Survey of Midlife Development in the United States, we estimate that 35 percent of the variance in regular smoking is due to additive genetic influences. When we disaggregate the sample by birth cohort we witness strong genetic influences on smoking for those born in the 1920s, 1930s, and 1950s, but negligible influences for those born in the 1940s and 1960s. We show that the timing of the first Surgeon General's Report coincides with an increase in the genetic influences on regular smoking, but subsequent legislation prohibiting smoking in public places has significantly reduced these influences. These results are in line with existing gene-environment interaction theory, and we argue that variation in genetic influences across cohorts makes it difficult and potentially misleading to estimate genetic effects on health behaviors from data obtained from a single point in time.

Ethnicity, body mass, and genome-wide data.

This article combines social and genetic epidemiology to examine the influence of self-reported ethnicity on body mass index (BMI) among a sample of adolescents and young adults. We use genetic information from more than 5,000 single nucleotide polymorphisms in combination with principal components analysis to characterize population ancestry of individuals in this study. We show that non-Hispanic white and Mexican-American respondents differ significantly with respect to BMI and differ on the first principal component from the genetic data. This first component is positively associated with BMI and accounts for roughly 3% of the genetic variance in our sample. However, after controlling for this genetic measure, the observed ethnic differences in BMI remain large and statistically significant. This study demonstrates a parsimonious method to adjust for genetic differences among individual respondents that may contribute to observed differences in outcomes. In this case, adjusting for genetic background has no bearing on the influence of self-identified ethnicity.

Sex differences in the heritability of resilience.

We examine the heritability of psychological resilience among US adults aged 25 to 74 years. Using monozygotic and same sex dizygotic twin pairs from the National Survey of Mid-Life Development in the United States (MIDUS) we show that positive affect is equally heritable among men (h2 = .60) and women (h2 = .59). We then estimate the heritability of positive affect after controlling for an exhaustive list of social and inter-personal stressors, and we operationalize the residual for positive affect as resilience. According to this specification, the heritability of resilience is higher among men (h2 = .52) compared to women (h2 = .38). We show that self-acceptance is one of the most important aspects of psychological functioning that accounts for the heritability of resilience among both men and women. However, compared to women, men appear to derive additional benefits from environmental mastery that may enable otherwise sex-neutral resilient tendencies to manifest.