Determinants of Low-Income Women's Participation in Self-Collected Samples for Cervical Cancer Detection: Application of the Theory of Planned Behavior.

BACKGROUND: Low-income women (LIW) are underrepresented in physician-provided cervical cancer screening. Providing women with an option for Human Papillomavirus (HPV) self-sampling would increase cervical cancer screening. However, little is known about LIW's attitude towards self-sampling for cervical cancer. We determined the associations between the Theory of Planned Behavior (TPB) constructs and LIW intention for participation in the HPV self-sampling. METHODS: A 44-item survey was administered among women receiving food from a food pantry in central Texas. Independent variables included TPB constructs (i.e., attitudes, subjective norms, and perceived control). The outcome variables were intentions and preference for self-sampling. Both variables were measured on a 5-point scale. Hierarchical linear regression models were used to analyze the data. RESULTS: A sample of 241 participants (age 50.13 ± 9.60 years) comprising non-Hispanic White (40%), Black/African American (27%), and Hispanic (30%) participated in the study. The participants were current with a pap test (54.8%) and preferred self-sampling (42%). The participant's attitudes and subjective norms were significantly associated with their intention for self-sampling, accounting for 38.7% of the variance (p < .001). Women who were overdue for pap testing versus current with pap testing had increased odds of preferring self-sampling (OR = 1.72, 95% CI: 1.27, 6.04). CONCLUSIONS: The key predictors for LIW's intention for self-sampling included attitudes and subjective norms. Future research should use the TPB as a framework to examine whether intention predicts self-sampling behavior among LIW.

HPV Self-Sampling for Cervical Cancer Screening among Women Living with HIV in Low- and Middle-Income Countries: What Do We Know and What Can Be Done?

INTRODUCTION: Self-sampling has the potential to increase cervical cancer (CC) screening among women with HIV in low- and middle-income countries (LMICs). However, our understanding of how HPV self-collection studies have been conducted in women with HIV is limited. The purpose of this scoping review was to examine the extent to which the HPV self-sampling has been applied among women with HIV in LMICs. METHOD: We conducted multiple searches in several databases for articles published between 2000 and January 2022. With the combination of keywords relating to HPV self-sampling, LMICs, and women with HIV, we retrieved over 9000 articles. We used pre-defined inclusion and exclusion criteria to select relevant studies for this review. Once a study met the inclusion criteria, we created a table to extract each study's characteristics and classified them under common themes. We used a qualitative descriptive approach to summarize the scoping results. RESULTS: A total of 12 articles were included in the final review. Overall, 3178 women were enrolled in those studies and 2105 (66%) of them were women with HIV. The self-sampling participation rate was 92.6%. The findings of our study show that 43% of the women with HIV in 8 of the studies reviewed tested positive for high-risk HPV (hr-HPV) genotypes, indicating 4 out of 10 women with HIV in the studies are at risk of cervical cancer. The prevalence of the hr-HPV in women with HIV was 18% higher than that of HIV-negative women. Most women in the study found the self-sampling experience acceptable, easy to use, convenient, and comfortable. Self-sampling performance in detecting hr-HPV genotypes is comparable to clinician-performed sampling. However, limited access (i.e., affordability, availability, transportation), limited knowledge about self-screening, doubts about the credibility of self-sampling results, and stigma remain barriers to the wide acceptance and implementation of self-sampling. In conclusion, the findings of this review highlight that (a) the prevalence of hr-HPV is higher among women with HIV than HIV-negative women, (b) self-sampling laboratory performance is similar to clinician-performed sampling, (c) the majority of the women participated in self-sampling, which could likely increase the cervical cancer screening uptake, and (d) women with HIV reported a positive experience with self-sampling. However, personal, environmental, and structural barriers challenge the application of self-sampling in LMICs, and these need to be addressed.

Assessment of university policies for service animals and emotional support animals.

OBJECTIVE: Assess administrative responsibilities and experiential effects of emotional support animal (ESA) and service animal (SA) policies on college campuses. PARTICIPANTS: Students at two four-year universities participated in an emotional support animals and service animals survey. Selected students and professional personnel participated in interviews and focus groups. METHODS: This mixed-methods study included quantitative survey data from 1,363 students, qualitative individual interviews (3) and a focus group (1) regarding emotional support animal (ESA) and service animal (SA). RESULTS: Seventy-one students reported having ESAs, 18 had SAs. Barriers for ESAs on campus included no ESAs outside of dorms, while SA-owners reported fewer barriers. University administrators followed federal guidelines for SAs but lacked clear guidelines for ESAs. Qualitative themes included lack of awareness, education, support for SA, and ESA accommodations. CONCLUSIONS: ESA and SA accommodations continue to rise, on university campuses. Clear guidelines and implementation processes are imperative for future improvements.

Predicting emotional abuse among a sample of college students.

Objective This study aims to examine factors related to emotional abuse, an understudied type of intimate partner violence (IPV), among a sample of college students. Participants: 601 undergraduates from one large public university in the Midwestern United States (Spring 2017) and 756 undergraduates from one large public university in the Southern United States (Fall 2019) participated in the study. Methods: Participants completed an online survey measuring demographic information, behavioral variables (viewing porn, alcohol consumption, and hooking up), and history of violence (witnessing a father abuse his spouse, emotional abuse history). Descriptive statistics and binary logistic regression analyses predicting emotional abuse victimization were conducted. Results: Results indicate female, white, older students were more likely to report emotional abuse. Also, students witnessing their father abuse his spouse, frequent pornography use, increased alcohol use, and frequent hookups increased odds of emotional abuse. Conclusion: College campuses should consider emphasizing emotional abuse in IPV programing.

Feasibility of Utilizing Social Media to Promote HPV Self-Collected Sampling among Medically Underserved Women in a Rural Southern City in the United States (U.S.).

BACKGROUND: Social media (Facebook, WhatsApp, Instagram, Twitter) as communication channels have great potential to deliver Human papillomavirus self-test (HPVST) intervention to medically underserved women (MUW) such as women of low income. However, little is known about MUW's willingness to participate in HPVST intervention delivered through social media. We evaluated factors that contribute to MUW's intention to participate in the social media-related intervention for HPVST. METHODS: A 21-item survey was administered among women receiving food from a local food pantry in a U.S. southern state. Independent variables were social media usage facilitators (including confidentiality, social support, cost, and convenience), and barriers (including misinformation, time-consuming, inefficient, and privacy concerns). Dependent variables included the likelihood of participating in social-driven intervention for HPVST. Both variables were measured on a 5-point scale. We used multinomial logistic regression to analyze the data. RESULTS: A total of 254 women (mean age 48.9 ± 10.7 years) comprising Whites (40%), Hispanics (29%), Blacks (27%), and Other (4%) participated in the study. We found that over 44% of the women were overdue for their pap smears for the past three years, 12% had never had a pap smear, and 34% were not sure if they had had a pap smear. Over 82% reported frequent social media (e.g., Facebook) usage, and 52% reported willingness to participate in social media-driven intervention for HPVST. Women who reported that social media provide privacy (Adjusted Odds Ratio (AOR) = 6.23, 95% CI: 3.56, 10.92), provide social support (AOR = 7.18, 95% CI: 4.03, 12.80), are less costly (AOR = 6.71, 95% CI: 3.80, 11.85), and are convenient (AOR = 6.17, 95% CI: 3.49, 10.92) had significantly increased odds of participating in social media intervention for HPVST. CONCLUSIONS: The findings underscore that the majority of the MUW are overdue for cervical cancer screening, regularly use social media, and are willing to participate in social media-driven intervention. Social media could be used to promote HPV self-testing among MUW.

Internal and External Validity of Social Media and Mobile Technology-Driven HPV Vaccination Interventions: Systematic Review Using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) Framework.

Social media human papillomavirus (HPV) vaccination interventions show promise for increasing HPV vaccination rates. An important consideration for the implementation of effective interventions into real-world practice is the translation potential, or external validity, of the intervention. To this end, we conducted a systematic literature review to describe the current body of evidence regarding the external validity of social media HPV vaccination-related interventions. Constructs related to external validity were based on the reach, effectiveness, adoption, implementation, maintenance (RE-AIM) framework. Seventeen articles published between 2006 and 2020 met the inclusion criteria. Three researchers independently coded each article using a validated RE-AIM framework. Discrepant codes were discussed with a fourth reviewer to gain consensus. Of these 17 studies, 3 were pilot efficacy studies, 10 were randomized controlled trials (RCTs) to evaluate effectiveness, 1 was a population-based study, and 3 did not explicitly state which type of study was conducted. Reflecting this distribution of study types, across all studies the mean level of reporting RE-AIM dimensions varied with reach recording 90.8%, effectiveness (72.1%), adoption (40.3%), implementation (45.6%), and maintenance (26.5%). This review suggests that while the current HPV vaccination social media-driven interventions provide sufficient information on internal validity (reach and effectiveness), few have aimed to gather data on external validity needed to translate the interventions into real world implementation. Our data suggest that implementation research is needed to move HPV vaccination-related interventions into practice. Included in this review are recommendations for enhancing the design and reporting of these HPV vaccination social media-related interventions.

An epidemiologic study of suicide among firefighters: Findings from the National Violent Death Reporting System, 2003 - 2017.

Suicide is a significant concern among fire service due to high rates of suicide behaviors. The aim of this study was to describe suicides among firefighters using national suicide death data. Data from the National Violent Death Reporting System for 722 firefighters and 192,430 non-firefighters were analyzed to compare sociodemographics and risk factors between firefighter and non-firefighter decedents; and among firefighters based on suicide means. A greater proportion of firefighter decedents died by firearm compared to non-firefighters. Firefighter decedents were less likely to have been diagnosed with depression, but more likely to have been diagnosed with post-traumatic stress disorder compared to non-firefighters. A greater percentage of firefighter decedents had a relationship or physical health problem prior to death, but a lower percentage had a history of suicide thoughts/attempts. Among firefighter decedents, multivariate analysis showed physical health problems and disclosing suicide intent predicted death by firearm. Greater awareness of risk factors, reduced access to lethal means, and ensuring access to behavioral health services may aide in decreasing suicide mortality in this population. These findings should be interpreted with caution due to limitations concerning report accuracy, generalizability, small female sample size, and inclusion of data only for lethal suicide attempts.

A Retrospective Cross-Sectional Study on the Prevalence of E-cigarette Use Among College Students.

E-cigarette use among young adults is a major public health concern. Approximately 17.7-40% of college students have tried or are currently using e-cigarettes. While a few studies have examined e-cigarette use among youth, opportunity exists to understand psychosocial factors that influence college students' e-cigarette behavior. The main purpose of this study is to examine the associations between the constructs of self-efficacy, knowledge, depression and anxiety symptoms, and e-cigarette use among college students. A retrospective cross-sectional survey (20-items) design was used for data collection. Bivariate analysis and analysis of variance (ANOVA) were used to evaluate associations between the independent variables and the dependent variable. A total of 872 college students between the ages of 18 and 25 completed the survey in Qualtrics. A significant association between gender and frequency of e-cigarette use was found (χ2 = 22.94, p < .001). ANOVA results showed significant relationships between knowledge [F (3, 808) = 9.01, p < 0.001], self-efficacy [F (3, 808) = 4.85, p < 0.01], depression [F (3,808) = 8.31, p < .05], and e-cigarette use. Post hoc analysis revealed students who never used e-cigarettes scored higher on knowledge and self-efficacy than students who used every day, somedays or rarely, indicating never-users have higher knowledge of negative effects associated with e-cigarette use and have higher self-confidence than e-cigarette users. The study's findings highlight that modifiable factors such as knowledge about harmful effects of e-cigarettes and self-confidence are associated with low e-cigarette use. Interventions could be designed to target these modifiable factors.

Human papillomavirus vaccination practices and perceptions among Ghanaian Healthcare Providers: A qualitative study based on multi-theory model.

BACKGROUND: Healthcare providers' (HCPs) recommendations for the Human Papillomavirus (HPV) vaccine are likely to increase the vaccination uptake. However, little is known about Ghanaian HCPs' general practices regarding HPV vaccination. We used Multi-Theory Model (MTM) constructs (i.e. participatory dialogue, behavioral confidence, environment, social and emotional transformation) to examine Ghanaian HCPs' attitudes towards HPV vaccination and their vaccination recommendation practices. METHODS: We conducted three, 60-minute focus group discussions (FGDs) with HCP in the second-largest government hospital in Ghana. Sixteen semi-structured open-ended questions based on MTM constructs were used to guide the FGDs. We explored HCPs' general knowledge about HPV, vaccination recommendation behavior, physical environment, and socio-cultural factors associated with the HPV vaccination. Data from the FGDs were transcribed and thematically coded using NVivo software. RESULTS: The sample of (n = 29) HCPs consisting of males (n = 15) and females (n = 14) between the ages of 29 and 42 years participated in the FGDs. Our analyses showed that HCPs (a) rarely offered HPV vaccination recommendations, (b) showed varied understanding about who should be vaccinated regarding age eligibility, gender, and infection status. Perceived barriers to HPV vaccination include (a) low urgency for vaccination education due to competing priorities such as malaria and HIV/AIDS; (b) lack of data on HPV vaccination; (c) lack of awareness about the vaccine safety and efficacy; (c) lack of HPV vaccine accessibility and (d) stigma, misconceptions and religious objections. HCPs expressed that their motivation for counseling their clients about HPV vaccination would be increased by having more knowledge about the vaccine's efficacy and safety, and the involvement of the parents, chiefs, churches, and opinion leaders in the vaccination programs. CONCLUSION: The study's findings underscore the need for a comprehensive HPV vaccination education for HCPs in Ghana. Future HPV vaccination education programs should include information about the efficacy of the vaccine and effective vaccination messages to help mitigate HPV vaccine-related stigma.

Peripheral neuropathy and depressive symptoms: examining the association in a primary health care setting among persons with and without diabetes mellitus.

PURPOSE: The purpose of this study was to measure the association between peripheral neuropathy symptoms and depressive symptoms among a sample of patients with and without diabetes mellitus (DM). METHODS: Patients were administered the 15-item Michigan Neuropathy Screening Instrument (MNSI) and the patient health questionnaire depression scale (PHQ-8). Patients with an MNSI score ≥ 4 were categorized as having PN and patients with a PHQ-8 score ≥ 10 were considered to have current depression. Log-binomial regression was used to analyze the relationship between PN and depressive symptoms. RESULTS: 406 patients were included in the final analysis. There were no statistically significant differences by diabetes status in PN symptoms (Diabetes = 61.8%; No diabetes = 55.4%; p = .20) or in depression status (Diabetes = 37.6%; No diabetes = 36.6%; p = .83). After adjustment for covariates, PN was associated with depression (aRR = 4.46; 95% CI 2.91,6.85) independent of diabetes status. CONCLUSIONS: PN symptoms may be common among aging persons even in the absence of DM. Past literature and our study demonstrate that PN and depression are closely associated. More work is needed to understand the etiology and potential utility of intervention for depression symptoms among patients with neuropathy.

Associations Between Social Capital and Depressive Symptoms Among College Students in 12 Countries: Results of a Cross-National Study.

INTRODUCTION: A mental health crisis has hit university campuses across the world. This study sought to determine the prevalence and social determinants of depressive symptoms among university students in twelve countries. Particular focus was placed on the association between social capital and depressive symptoms. METHODS: A cross-sectional study was conducted among students at their first year at university in Europe, Asia, the Western Pacific, and Latin and North America. Data were obtained through a self-administered questionnaire, including questions on sociodemographic characteristics, depressive symptoms, and social capital. The simplified Beck's Depression Inventory was used to measure the severity of depressive symptoms. Social capital was assessed using items drawn from the World Bank Integrated Questionnaire to Measure Social Capital. Multilevel analyses were conducted to determine the relationship between social capital and depressive symptoms, adjusting for individual covariates (e.g., perceived stress) and country-level characteristics (e.g., economic development). RESULTS: Among 4228 students, 48% presented clinically relevant depressive symptoms. Lower levels of cognitive (OR: 1.82, 95% CI: 1.44-2.29) and behavioral social capital (OR: 1.51, 95% CI: 1.29-1.76) were significantly associated with depressive symptoms. The likelihood of having depressive symptoms was also significantly higher among those living in regions with lower levels of social capital. CONCLUSION: The study demonstrates that lower levels of individual and macro-level social capital contribute to clinically relevant depressive symptoms among university students. Increasing social capital may mitigate depressive symptoms in college students.

Multi-Theory Model and Predictors of Likelihood of Accepting the Series of HPV Vaccination: A Cross-Sectional Study among Ghanaian Adolescents.

HPV vaccines are efficacious in preventing HPV related cancers. However, the vaccination uptake in Ghana is very low. Studies that utilize theoretical frameworks to identify contributory factors to HPV vaccination uptake in Ghana are understudied. We used multi-theory model (MTM) constructs to predict initiation and completion of HPV vaccination series in Ghanaian adolescents. Adolescents (n = 285) between the ages of 12 and 17 years old were recruited from four selected schools in Ghana to participate in the cross-sectional study. Linear regressions were used to analyze the data. Most participants were female (91.2%) and senior high school students (60.0%). Many of the participants had neither heard about HPV (92.3%) nor HPV vaccinations (95.4%). Significant predictors of adolescents' likelihood of getting the first dose of HPV vaccination were perceived beliefs and change in a physical environment (p < 0.001), with each variable accounting for 6.1%and 8.8% of the variance respectively. Significant predictors of adolescents' likelihood of completing HPV vaccination recommended series were perceived beliefs, practice for change, and emotional transformation (p < 0.001), with each variable accounting for 7.8%, 8.1%, and 1.1% of the variance respectively. Findings underscore important opportunities for developing educational interventions for adolescents in Ghana to increase the HPV vaccination uptake.

A Systematic Review of Dating Violence Risk Factors Among Undergraduate College Students.

College students are a vulnerable population for dating violence (DV) because of the social environment in which they live and interact with other students. Campus climate surveys are considered best practice for gathering information about the severity and cause of college DV; however, there are still unanswered questions as to why DV remains an alarming public health concern among college students. The aim of this systematic literature review was to examine DV risk factors specific to college students with a special focus on methodological factors and gaps in the literature. Databases EBSCO, Scopus, PsycINFO, MEDLINE, ERIC, and PubMed were searched for articles published between 2006 and 2016, resulting in 23 articles that met inclusion criteria for this review. Very few studies were conducted at private universities (n = 4). Most researchers used descriptive cross-sectional surveys (n = 22), while only one utilized a mixed-methods approach. Measurement scales used to collect DV rates were similar across studies, yet the definition of DV was inconsistent. Types and severity of DV varied across studies, but overall, females were more likely to perpetrate and/or experience DV than males. Individual risk factors (e.g., substance use, risky sexual behaviors) were identified more often than family risk factors (e.g., intergenerational violence) and peer and social risk factors (e.g., Greek-life or athletic team membership, relationship type). A better understanding of new college relationships is critical to identify modifiable risk factors for DV. Recommendations for future practice and research are also discussed.

Sex Education and HIV Testing Among Young Men Who Have Sex With Men: Findings From the 2006-2010 and 2011-2015 National Survey of Family Growth.

BACKGROUND: Young men who have sex with men (YMSM) are disproportionally affected by HIV and exhibit low levels of HIV testing. The purpose of this study was to examine the relationship between sex education and subsequent HIV testing among YMSM. METHODS: Data from sexually active men aged 15-24 years at interview in the 2006-2010 or 2011-2015 National Survey of Family Growth. Sex education included 3 contexts [formal institutions (eg, schools), parents, and health care providers] and specific topics. Outcome variables were ever- and recent-HIV testing. Multivariate models were adjusted for sociodemographics, and data were weighted to account for the complex survey sampling design. RESULTS: A total of 323 sexually active YMSM met inclusion criteria. Overall, 42.4% had ever-tested for HIV and 16.9% tested in the previous 12 months. YMSM were more likely to have ever-tested for HIV if they talked with a parent/guardian about how to prevent HIV/AIDS [adjusted prevalence ratio (aPR) = 1.48; 95% confidence interval (CI): 1.07 to 2.06], talked with a health care provider about how HIV/AIDs is transmitted (aPR = 1.64; 95% CI: 1.13 to 2.38), sexually transmitted diseases (aPR = 1.49; 95% CI: 1.02 to 2.19), condom use (aPR = 1.61; 95% CI: 1.13 to 2.30), and the importance of HIV testing (aPR = 1.83; 95% CI: 1.22 to 2.73). CONCLUSIONS: Tailored sex education by parent(s) and health care providers related to HIV/AIDS seems to significantly increase the likelihood of HIV testing among YMSM.

Simple screening tools to identify limited health literacy in a low-income patient population.

Adults with limited health literacy have difficulty managing chronic conditions, higher hospitalization rates, and more healthcare expenditures. Simple screening tools have been developed, but limited work has evaluated instruments among low-income populations. This study assessed health literacy among primary care patients of a federally qualified health center, and compared a single screening question about perceived difficulty completing medical forms.A cross-sectional survey was administered to English-speaking patients ≥40 years. Both the Newest Vital Sign (NVS), a 6-item questionnaire, and a single-item screening question about perceived difficulty with completing medical forms, assessed health literacy. Logistic regression was used to identify predictors of inadequate health literacy and receiver operator curves compared the NVS and single-item question.Participants (n = 406) were, on average, aged 58.5 years (±11.3), 72.2% female, and identified as Hispanic/Latino (19.2%), non-Hispanic white (31.0%), non-Hispanic black (40.9%), or other (8.9%). Of the 406 participants, 335 (82.5%) completed the NVS. Patients who declined NVS were more likely to be older (P < .001) and male (P = .01). Only 13.7% had adequate health literacy. Older adults, Hispanic and non-Hispanic black patients, patients with missed office visits, and those reporting less confidence completing medical forms were significantly more likely to have inadequate health literacy. Perceived confidence completing medical forms demonstrated low sensitivity but high specificity at multiple thresholds.This is the first investigation to compare the NVS and confidence completing medical forms question. Many patients declined health literacy assessments, but health literacy screening may identify patients who need additional health education and resources.

Changes in Cardiorespiratory Responses and Kinematics With Hippotherapy in Youth With and Without Cerebral Palsy.

PURPOSE: The purpose of this study was to characterize pelvic displacement and cardiorespiratory responses to simulated horseback riding and walking in youth with cerebral palsy and to compare responses to youth without cerebral palsy before and after 8 weeks of hippotherapy. METHOD: Eight youth with cerebral palsy (Mage = 10 ± 4 years; Mheight = 137 ± 24 cm; Mweight = 32 ± 16 kg) and 8 youth without cerebral palsy (Mage = 11 ± 2 years; Mheight = 149 ± 14 cm; Mweight = 48 ± 15 kg) underwent a hippotherapy intervention. Participants completed simulated horseback riding at an intensity approximating a fast walk (0.65 Hz) and walked on a treadmill (1 mph, 0% grade) before and after hippotherapy. Pelvic displacement along the anterior-posterior, vertical, and medial-lateral axes, heart rate, oxygen consumption, ventilation, and blood pressure were measured at rest and during steady-state exercise in both exercise modes. RESULTS: Kinematics and cardiorespiratory responses were similar between the 2 groups during simulated horseback riding (p > .05 for all) before the intervention. Significantly greater cardiorespiratory responses were observed in the youth with cerebral palsy compared with the group without cerebral palsy while walking before and after the intervention (p <  .05, effect sizes 26% to 237% greater). Eight weeks of hippotherapy did not alter responses, but anecdotal improvements in gait, balance, posture, and range of motion were observed in those with cerebral palsy. CONCLUSION: These results contribute to our understanding regarding the efficacy of hippotherapy as an intervention to improve functional abilities in those with cerebral palsy.

Not Just Horsing Around: The Impact of Equine-Assisted Learning on Levels of Hope and Depression in At-Risk Adolescents.

Equine-assisted learning (EAL) is an experiential modality which utilizes horses to provide a unique learning experience for personal growth. Research by Damon et al. (Appl Dev Sci 7:119-128, 2003) suggests a positive relationship between hope and positive developmental trajectories. Hagen et al. (Am J Orthopsychiatr 75:211-219, 2005) showed hope to be a protective factor associated with adaptive functioning in at-risk youth. Ashby et al. (J Couns Dev 89:131-139, 2011) found a significant inverse relationship between hope and depression: as hope increases, depression decreases. The current study investigates the impact of a non-riding EAL curriculum entitled L.A.S.S.O. (Leading Adolescents to Successful School Outcomes) on levels of hope and depression in at-risk youth. The study uses an experimental design with longitudinal, repeated measures. Participants were randomly assigned to treatment and control groups. Participants in the treatment received 5 weeks of EAL, while participants in the control group received treatment as usual. Repeated measures ANOVA of participants' levels of hope and depression showed statistically significant improvements in the treatment group as compared with the control group. Even a brief (5-week) intervention of EAL had a positive impact on the lives and attitudes of at-risk adolescents, with increased levels of hope and decreased levels of depression.

Effects of equine assisted activities on autism spectrum disorder.

Quality of life assessments were used in this study to determine the behavioral changes of children diagnosed with autism spectrum disorder (ASD) who participated in equine assisted activities. Behavioral changes of children with ASD participating in 9 weeks of equines assisted activities (EAA) (N = 10) were compared to behavioral changes of children who participated in a non-equine intervention (N = 8). Parents noted significant improvements in their child's physical, emotional and social functioning following the first 6 weeks of EAA. The children participating in the non-equine program also demonstrated improvement in behavior, but to a lesser degree. The favorable outcome of this study lends support for continuation of programs utilizing EAA in the treatment of children with ASD.

Cross-lagged relationships among leisure-time exercise and perceived stress in blue-collar workers.

Blue-collar workers (N = 203) from a large food-processing plant in the southwestern U.S. completed measures of perceived stress and leisure-time exercise at an initial test session in addition to a 2-month follow-up session. Mean age of the sample participants equaled 43.61 (SD = 9.79), and 69.5% of the sample were male, 71.4% were Caucasian, and 74.9% were married/cohabitating. Structural equation modeling was employed to examine the cross-lagged relationships between perceived stress and leisure-time exercise at these time points, controlling for gender, marital status, age, and yearly household income. Results indicated that a model with a path from perceptions of Time 1 stress to Time 2 exercise frequency was most parsimonious and provided acceptable model fit, suggesting that perceptions of stress are related to reductions in exercise participation in this population. However, there was little support for a relationship between Time 1 exercise participation and Time 2 perceived stress.