The four stages of neighborhood trust: Classic grounded theory.

INTRODUCTION: Neighborhoods are often overlooked as a determinant of health. Among recent research, the focus on "place-based effects," due to prolonged residential environmental exposure, has been of particular interest. These studies' purpose is to identify and examine how a healthy neighborhood is intentionally created to describe a transferable process-driven theory. METHOD: A classic grounded theory approach was used in these studies. Data sources include individual in-depth interviews, historical documents, and a member-checking focus group, collected over 3-years. RESULTS: Analysis generated the Four Stages of Neighborhood Trust Model, which is nested within the context of perceived neighborhood safety. The theory outlines a social process of four stages of neighborhood trust: (a) rules-based agreements, (b) shared values, (c) cooperation, and (d) neighborhood belonging. CONCLUSIONS: We present the development of a process-driven theory that may be useful for public health nurses as they engage neighborhoods in health promotion activities. The stage of trust development will aid the nurse in identifying what is needed to move to the next stage in a healthy neighborhood process.

Agricultural Worker Perspectives on Climate Hazards and Risk Reduction Strategies.

OBJECTIVE: The purpose of this study was to understand the experiences of agricultural workers during periods of heat and wildfire smoke exposure and to support the development and implementation of protective workplace interventions. METHODS: Using community-engaged research and the Center for Disease Control (CDC) framework for policy evaluation, a qualitative descriptive study was conducted with current and former agricultural workers in Central Washington (WA). Twelve participants answered semi-structured questions via interviews or by attending a focus group. Interviews and focus groups were conducted in Spanish, recorded, transcribed, and translated into English; one interview was conducted in English. RESULTS: Using Braun and Clarke's Reflexive Thematic Analysis, five themes were identified among workers from various worksites: 1) Extreme weather and working conditions are becoming increasingly hazardous to worker health, 2) Employers and supervisors lack training and education on current labor laws, and health and safety rules, 3) Employers and supervisors use intimidation and retaliation to ensure productivity and to evoke feelings of replaceability among workers, 4) Workers do not trust regulatory agencies to enforce rules or hold employers accountable, 5) Solutions to climate-driven problems in the agricultural industry need to value worker health and safety, not just productivity. Participants reported experiencing adverse health symptoms related to heat and smoke exposure at work. Workers proposed solutions including improving education, training, and communication, and increased enforcement of existing and forthcoming occupational health and safety rules. CONCLUSION: The agricultural workforce is essential for ensuring a robust food supply and is facing extreme weather events due to climate change. Western states impacted by wildfires and heat are working to develop and implement occupational health and safety rules. Developing effective policies and interventions inclusive of worker perspectives is critical to adapt to a changing climate, retain a stable workforce and promote optimal health.

Flexible Resources Key to Neighborhood Resilience for Children: A Scoping Review.

Neighborhoods have been the focus of health researchers seeking to develop upstream strategies to mitigate downstream disease development. In recent years, neighborhoods have become a primary target in efforts to promote health and resilience following deleterious social conditions such as the climate crisis, extreme weather events, the global pandemic, and supply chain disruptions. Children are often the most vulnerable populations after experiencing unexpected shocks. To examine and describe conceptually the construct of Neighborhood Resilience, we conducted a comprehensive scoping review using the terms ("resilience" or "resiliency" or "resilient") AND ("neighborhood"), utilizing MEDLINE (through PubMed) and CINAHL (through EBSCOhost) databases, to assess overall neighborhood themes that impact resilience. A total of 57 articles were extracted that met inclusion criteria. Extracted characteristics included study purpose, country of origin, key findings, environmental protective/risk factors. The analysis revealed a positive relationship between neighborhood resource density, neighborhood resiliency, and individual resiliency. This study reports the finding for studies with a population focus of pre-school age and school age children (1.5-18 years of age). Broadly, we identified that the primary goals regarding neighborhood resilience for childhood can be conceptualized as all activities and resources that (a) prevent trauma during childhood development and/or (b) mitigate or heal childhood trauma once it has occurred. This goal conceptually encompasses antecedents that increase protective factors and reduces risk factors for children and their families. This comprehensive look at the literature showed that a neighborhood's ability to build, promote, and maintain resiliency is often largely dependent on the flexible resources (i.e., knowledge, money, power, prestige, and beneficial social connections) that are available.

Feasibility and acceptability of home monitoring with portable spirometry in young adults with asthma.

OBJECTIVE: Self-monitoring asthma control is a key component of asthma management. Few studies have reported usability and acceptability of portable spirometry among young adults with asthma. Portable spirometry offers a practical solution to monitoring airway narrowing at home. The purpose of this paper was to determine if self-administered spirometry is feasible and acceptable in young adults with asthma and whether regular monitoring resulted in improved airway function as measured by forced expiratory volume in one second (FEV1). METHODS: Sixty-seven young adults (18-26 years) with self-reported asthma participated in a clinical trial during wildfire season which measured FEV1 as an outcome measure. Data was collected at baseline, week 4, and week 8 using a portable spirometer linked to a smartphone application. A subset of intervention participants completed spirometry twice daily. Acceptability of self-administered spirometry was evaluated after the trial among participants that volunteered to submit a survey and be interviewed. RESULTS: At baseline, all 67 participants (100.0%) completed their scheduled spirometry readings which declined to 94.0% (n = 63) at week 4 and 86.6% (n = 58) at week 8. Daily readings were completed 83.2% of the time in the mornings and 84.3% of the time in the evenings. Mean FEV1 values were lower than predicted values, but above the lower limit of expected. FEV1 remained steady throughout the study period. Over two-thirds of participants used the notes feature in the application and described symptoms, asthma triggers, mitigating actions and test-taking issues. CONCLUSIONS: Young adults in our sample were highly compliant with regular, self-administered spirometry.

Assessing community response to wildfire smoke: A multimethod study using social media.

OBJECTIVE: The purpose of this study was to assess health-related responses to wildfire smoke on social media. We examined whether seasonal wildfire smoke is an active topic on Twitter, the correlation between fine particulate matter (PM2.5 ) and Twitter search terms, and dimensions of community-level expression to wildfire smoke through tweets. DESIGN: Search terms were identified using a conceptual model developed and refined by healthcare providers and public health experts. Wildfire-related tweets were downloaded from Twitter users in Spokane, Washington during the 2017 and 2018 wildfire seasons. PM2.5 data were correlated with the search terms. A subset of tweets was deductively and then inductively coded to identify perceptions and behavioral responses to wildfire smoke. RESULTS: Seasonal wildfire smoke is an active topic on Twitter. The term "smoke" was strongly correlated with poor air quality and "unhealthy" was moderately correlated. Deductive analyses revealed a multidimensional response to wildfire smoke. Inductive analysis identified new areas of concern, such as pet and animal health. CONCLUSIONS: Social media is a lens through which public health professionals can assess and respond to local community needs. Findings will be used to broaden the conceptual model, enhance ongoing surveillance of community-identified health risks, and communicate protective actions.

Allostatic Load Measurement: A Systematic Review of Reviews, Database Inventory, and Considerations for Neighborhood Research.

BACKGROUND: Neighborhoods are critical to understanding how environments influence health outcomes. Prolonged environmental stressors, such as a lack of green spaces and neighborhood socioeconomic disadvantage, have been associated with higher allostatic load levels. Since allostatic load levels experienced earlier in life have stronger associations with mortality risk, neighborhoods may be uniquely suited to monitor and mitigate the impacts of environmental stressors. Researchers often study allostatic load in neighborhoods by utilizing administrative boundaries within publicly accessible databases as proxies for neighborhoods. METHODS: This systematic review of reviews aims to identify commonly used biomarkers in the measurement of allostatic load, compare measurement approaches, inventory databases to study allostatic load, and spotlight considerations referenced in the literature where allostatic load is studied in neighborhoods. The review was conducted using the search term "allostatic load" in the MEDLINE, CINAHL, and PsychINFO databases. The search results were filtered to include reviews. RESULTS: The search returned 499 articles after deduplication. Overall, 18 synthesis reviews met the inclusion criteria and were retained for extraction. The synthesis reviews analyzed represented 238 studies published from 1995 to 2020. The original ten biomarkers were most often used to measure allostatic load. More recently, body mass index and C-reactive protein have additionally been frequently used to measure allostatic load burden. CONCLUSIONS: The scientific contributions of this study are that we have identified a clear gap in geographic considerations when studying allostatic load. The implication of this study is that we have highlighted geographic concepts when conducting neighborhood-level research using administrative databases as a neighborhood proxy and outlined emerging future trends that can enable future study of allostatic load in the neighborhood context.

"Is It Good or Bad for the Air?" Latino and Asian Pacific Islander Youth-Led Messaging and Action for Environmental Justice Through Photovoice.

Photovoice is a powerful way to generate youth reflection and social action for health promotion. While the literature offers numerous examples of photovoice studies involving youth, they are most often engaged in taking, dialoguing, and developing phototexts, but not always in the critical next stages of planning what to do with this data, in terms of analyzing and then planning change-related strategic actions. This article describes the ways in which an intergenerational environmental justice project, as part of a larger community-based participatory research program, engaged youth through all stages of a photovoice project. Latino and Asia Pacific Islander adults recruited their own and other youth to conduct a photovoice and air sample data collection, analysis, exhibition, and evaluation activity focused on addressing indoor environmental justice threats from volatile organic chemicals. We offer lessons learned and reflect on the role of intergenerational collaboration to support youth in applying a critical lens for analyzing photovoice data and advocacy for health in their communities. We conclude with implications for photovoice practice and research.

Promoting risk reduction among young adults with asthma during wildfire smoke: A feasibility study.

OBJECTIVE(S): This study explored the feasibility, acceptability, preliminary impact, and functionality of two risk reduction mobile application (app) interventions on asthma outcomes as compared to a control arm during wildfire season. DESIGN: Three-arm, 8-week randomized clinical trial. SAMPLE: Sixty-seven young adults with asthma were enrolled. MEASUREMENTS: The Asthma Control Test, forced expiratory volume in one second (FEV1 ) and the System Usability Scale were measured at baseline, 4, and 8 weeks. The Research Attitude Scale was administered at 8 weeks. Twenty participants from the two intervention arms completed an optional survey and six were interviewed after completing the study. INTERVENTION: Both intervention arms could access Smoke Sense Urbanova, an app that supports reducing risks from breathing wildfire smoke. The Smoke Sense Urbanova Plus arm also monitored their daily FEV1 , received air quality notifications, and accessed preventive tips and a message board. RESULTS: Most participants agreed the app and spirometer were usable and their privacy and confidentiality were maintained. No adverse events were reported. CONCLUSIONS: Participant-identified recommendations will support intervention refinement and testing. This research supports asthma self-management tools that public health nurses and community health workers can recommend for at-risk populations.

Adapting and Testing the Self-Efficacy in Environmental Risk Reduction Instrument Among Spanish-Speaking Populations.

BACKGROUND AND PURPOSE: The purpose of this study was to adapt and test the Self-Efficacy in Environmental Risk Reduction instrument in a Spanish-speaking population. METHODS: Harkness' model of cross-cultural survey design was used to adapt the instrument. We sampled 95 adult, Spanish speakers from a federally qualified health clinic. Exploratory factor analysis with maximum likelihood estimation was used to analyze the factor structure. RESULTS: A 1-factor model provided the best fit to the data. The latent construct of the instrument is household environmental health self-efficacy. All items loaded higher than 0.610, indicating each item explains at least 36% variance in the latent construct. Cronbach's alpha indicates the scale has high internal consistency (α = .92). CONCLUSIONS: Respondents conceptualize self-efficacy in environmental risk reduction as practical solutions to minimize household risks.

Measuring Our Success in Teaching Latinos about Asthma and Home Environments: Lessons Learned from an Intervention Developed through Photovoice.

BACKGROUND: Childhood asthma management is an environmental justice concern for immigrant Latino parents. Photovoice methods have empowered our community-based participatory research (CBPR) team of Latino parents of children with asthma to investigate and educate others about indoor environmental threats in our community. METHODS: Data collection and management in evaluating interventions in such settings is under-described in the literature. We developed a culturally tailored educational intervention, guided by social cognitive theory, using photographs from our archive. We pilot tested this intervention with a convenience sample of Latino parents (n = 19) attending an English language literacy class. We designed and implemented a pre- and post-evaluation survey on self-efficacy and knowledge and collected observational notes. However, we found that the responses to the knowledge questions were of limited value. LESSONS LEARNED: We describe the lessons we learned regarding data collection, management and evaluation. CONCLUSIONS: We provide suggestions for improving survey design and data management for culturally tailored educational interventions.

Protecting Outdoor Workers From Hazards Associated With Wildfire Smoke.

Wildfires are increasing in frequency and intensity, which increases outdoor workers' risk of breathing smoke for sustained periods. Occupational health nurses have multiple roles to play to protect outdoor workers from the new "smoke season."

Balance, Health, and Workplace Safety: Experiences of New Nurses in the Context of Total Worker Health.

Transitioning into independent professional practice may be a difficult and trying process for newly licensed nurses, who may be at risk for burnout and quitting their jobs. Issues related to new nurses' well-being at work may also impact their personal lives. Using thematic analysis within the framework of Total Worker Health, this study examined factors related to the overall work, safety, and health of newly licensed nurses that should be addressed in work environments to promote well-being and prevent burnout and attrition. The main component of Total Worker Health is to find and understand the relevant issues that lead to safety and health risks in the workplace and affect workers' well-being at work and home. The overarching concept of Balance between Work and Life included three main themes: Health, Work Environment, and Learning to Be (a nurse). These themes with their subthemes described the difficulties participants had in balancing the complex interactions of work conditions and social life changes during the transition from student to professional nurse. Participants identified new physical health problems, mental health challenges, physical violence, lack of support structures at work, and alterations in family and friend relationships. However, they also developed protective factors from new connections with coworkers. These findings showed that new nurses are vulnerable to many factors at home and work that affect well-being and may lead to burnout and attrition. Implications include interventions at work that focus on health promotion, group support, and safety risk prevention through occupational nurse management.

Development and Pilot Testing of a Bilingual Environmental Health Assessment Tool to Promote Asthma-friendly Childcares.

BACKGROUND: Childhood marks the highest risk for allergic sensitization to asthma triggers. Hispanic/Latino children are at higher risk for hospitalization for asthma than non-Hispanic White children. Childcare providers lack knowledge about reducing asthma triggers. OBJECTIVES: The purpose of this paper is to describe a community-based participatory research (CBPR) initiative aimed at developing and pilot testing a bilingual walk-through assessment tool for asthma-friendly childcare environments. METHODS: Ten Latina mothers of children with asthma living in the Pacific Northwest collaborated with research partners to develop and pilot test a Childcare Environmental Health (CEH) assessment walk-through survey.Results and Lessons Learned: The women innovated the survey with photography and structural examinations of stress and provision of basic needs. The survey tool identified environmental threats to asthma in all three childcares surveyed. CONCLUSIONS: Parents are well-positioned to build trust with childcare providers, assess asthma triggers, and recommend practical mitigation strategies.

A National Survey Examining Manuscript Dissertation Formats Among Nursing PhD Programs in the United States.

PURPOSE: Among research-focused nursing doctoral (PhD) programs in the United States, the traditional dissertation format has recently given way to a series of publication-ready manuscripts, often bookended by introduction and conclusion chapters. To help programs make decisions about the use of these formats, this study undertook a national survey of programs offering PhDs in nursing. The purpose of this study was to explore the advantages and disadvantages of the traditional format versus manuscript option for dissertations among nursing PhD programs in the United States. DESIGN: Cross-sectional census survey of U.S. nursing PhD programs. METHODS: A web-based survey was administered to all U.S. nursing PhD programs. Respondents indicated formats offered, factors contributing to decisions of which formats to offer, and lessons learned. Descriptive statistics and inductive content analyses were used for analysis. FINDINGS: Of 121 eligible institutions, 79 provided eligible responses (66.7%). The majority (59%) offered both formats; 11% offered the manuscript option only, and 24% offered the traditional format only. Faculty support (or lack thereof) contributed to adoption (or not) of the manuscript option. Respondents' approaches to the manuscript option (e.g., number of papers) and advice are summarized. CONCLUSIONS: Manuscript option dissertations are commonly offered and provide benefits to students and faculty; however, thoughtful implementation is critical. Programs need to agree upon clear expectations and have graduate school support (e.g., formatting). Faculty need mentorship in advising manuscript option students who choose to use this format, and the time and support. Finally, students need additional writing skills that could be provided through coursework or via individual work with mentors. CLINICAL RELEVANCE: As nursing education continues to expand further into doctoral research, programs must examine dissertation formats in order to both prepare future nurse scholars and disseminate nursing research that is critical to improving nursing education, patient care, and clinical practice.

Assessing the value of the Meaningful Use Clinical Summary for patients and families with pediatric asthma.

Electronic clinical summaries are innovations supported by the Electronic Health Record Incentive Program, known as "Meaningful Use" (MU). The MU clinical summary documents the shared understanding of the plan of care for patients and assists families in managing asthma-related health care. The purpose of this analysis was to identify the communicative value of the summaries to patients and families. Readability measurements, content analysis, and descriptive statistics were employed in a review of twenty clinical summaries and compared with provider encounter notes. The average age of the patients from whom we collected clinical summaries was six years old. The average reading level of the summaries was ninth grade. Neither summaries nor health education contained visual images. There was a total of nine different asthma diagnoses. A full list of diagnoses was present in 45% of summaries. The average medications per patient was 5.75, and there were multiple medication changes noted (dosage adjustment, add, discontinued). Allergies, vital signs, and smoking status were reliably reported (99-100%). Provider orders present included medication, follow up, and return to the clinic instructions. The plan of care was replicated on 45% of summaries. There was variable reporting of various asthma guidelines. Opportunities to improve the clinical summary include using plain language to promote readability, action, understanding, and health literacy, training providers to standardize their documentation and include asthma action plans, and configuring EHR settings to ensure diagnoses and plan of care is carried over from provider notes to the summary.

Interactive CO-learning for Research Engagement and Education (I-COREE) Curriculum to Build Capacity Between Community Partners and Academic Researchers.

The voice of diverse communities continues to be minimal in academic research. Few models exist for education and training of new research topics and terminology and building partnership capacity in community-engaged research. Little is known about integrative education and training when building participatory research partnerships for sustainability and developing trust and rapport. Community partners at an Asian community-based health and social services center in a large metropolitan area wanted to explore the cultural context of a health-assistive smart home that monitors and auto-alerts with changes in health. With historical and recent rising trends in culturally insensitive research in several diverse communities, the concept of technology-enabled monitoring in the privacy of one's home brings uncertainty. Academic nurse researchers and community partners co-created a culturally safe integrative education and training curriculum, the Interactive CO-learning for Research Engagement and Education (I-COREE). The purpose was to design, implement, and evaluate the curriculum to respond to the community partners' needs to create a culturally safe space through an integrative education and training to facilitate building partnership capacity for research engagement including developing trust and rapport and addressing uncertainties in health-assistive technologies. Popular education tenets informed the curriculum. Twelve academic and community partners participated, four were team teachers who co-led the session. Implementation of the experiential, multimodal co-learning activities were conducted within ahalf-day. The curriculum evaluation indicated that it helped bridge critical conversations about partners' fears of the unknown, approach culturally sensitive topics safely, and trust and rapport. Key elements may be translatable to other partnerships.

Nursing Students' Perceptions of the Transition to Shift Work: A Total Worker Health Perspective.

Nursing students make an abrupt transition from traditional classes to clinical rotations and shift work. Little is known about students' sleep, sleep disturbances, and safe practice behaviors during this critical phase of professional development. The purpose of this study was to identify nursing students' perceptions of problems and potential solutions related to shift work and long work hours. This qualitative, descriptive study used two nursing student focus groups which engaged in a two-round participatory process aimed at framing future interventions. Participants identified problems and solutions related to personal and workplace well-being. Findings will inform undergraduate curricular revisions, and hospital hiring and managerial practices.

Psychometric Properties of the Nurses' Environmental Awareness Tool.

BACKGROUND AND PURPOSE: Nurses are committed to practice in an environmentally safe and healthy manner. However, nursing practice contributes significant negative impacts to the natural environment. We analyzed the psychometric properties of the Nurses Environmental Awareness Tool (NEAT), composed of 6 subscales, measuring awareness of environmental impacts and their health risks and ecological behaviors at work and home. METHODS: The NEAT was given to 689 nurses via online survey software. Exploratory factor analyses and Cronbach's alpha were examined for each of the 6 subscales. RESULTS: The 6 subscales resulted in one-factor models with items demonstrating adequate reliability (α > .67). CONCLUSIONS: The NEAT is a psychometrically sound scale to measure nurses' awareness and behavior related to environmental impacts of nursing practice.

Why didn't I know? Perspectives from adult children of elderly parents with dementia.

PURPOSE: Approximately 27 million adults are living with undiagnosed dementia worldwide. The purpose of this study was to learn about the experiences of adult children of elderly parents who were ultimately diagnosed with dementia. DATA SOURCES: A descriptive qualitative design was used for identifying if there were prodromal signs or symptoms that preceded the more commonly known warning signs of dementia. Twelve, 60-min interviews were conducted over the telephone. CONCLUSIONS: The overarching theme was: "Why didn't I know?" Subthemes were "We ignored it because we didn't want it to be," "We thought it was grief," and "They wouldn't diagnose dementia." Normal aging changes often mask the identification of mild cognitive impairment (MCI) and dementia. Healthcare providers should screen patients for dementia when cognitive concerns or changes become apparent. IMPLICATIONS FOR PRACTICE: The General Practitioner Assessment of Cognition and the Mini-Cog can be used for screening cognitive changes. Since depression may be misinterpreted as dementia, screening for depression should also be included if there is a potential for overlap. This is important in those patients who are experiencing grief, as many signs and symptoms of early grief are the same as early dementia.