Did the COVID-19 experience change U.S. parents' attitudes towards HPV vaccination? Results from a national survey.

BACKGROUND: In the U.S., uptake of the HPV vaccine remains below coverage goals. There is concern that negative reactions to emergency initiatives during the COVID-19 pandemic, including vaccination, may have increased some parents' hesitancy towards all vaccines, including HPV. Understanding how different parent populations view routine vaccination post-pandemic is key to strategic efforts to maintaining and increasing uptake of HPV vaccine. METHODS: In early 2022, we recruited an online panel of English-speaking U.S. parents and caregivers, who used the social media platform Twitter and had HPV vaccine-eligible but unvaccinated children age 9-14 years. Respondents completed a 20-minute survey measuring knowledge, attitudes and intentions regarding HPV vaccination for their child, as well as background socio-demographics and health information-seeking practices. Questions regarding experiences during the COVID-19 pandemic included changes in access to preventive care, and perceptions of whether pandemic experiences had positively or negatively affected their attitudes about routine vaccination, with open text capturing reasons for this change. RESULTS: Among 557 respondents, 81 % were definitely or likely to vaccinate their child against HPV, with 12 % being uncertain, and 7 % unlikely to vaccinate. Regarding routine vaccination, most (70 %) felt their attitudes had not changed, while 26 % felt more positively, and only 4 % felt more negatively. Reasons for positive attitude change included increased appreciation for vaccines overall, and motivation to proactively seek preventive care for their child. Negative attitude changes stemmed from distrust of COVID-19 public health efforts including vaccine development, and disillusionment with vaccines' ability to prevent disease. In multivariable models, intention to vaccinate was greater among parents reporting greater education, Democratic affiliation, greater religiosity, and urban residence. Negative attitude change due to the pandemic independently predicted reduced HPV vaccination intention, while positive attitude change predicted positive intention. CONCLUSIONS: Post-pandemic, most U.S. parents remain committed to vaccinating their children against HPV. However, addressing residual COVID-19 concerns could improve uptake among vaccine-hesitant parents.

People's perception of changes in their abortion attitudes over the life course: A mixed methods approach.

Research examining the extent that people's attitudes toward abortion vary across the life course is mixed. Some studies do not show a strong relationship between abortion attitudes and life stage, while others do find strong associations in both directions-older age associated with both more and less favorable attitudes toward legal abortion. Taken together, these findings suggest that individual attitudes toward abortion are static for some but malleable for others. Little is known about the prevalence, reasons, and directionality of attitude changes. This explanatory sequential mixed methods study investigates people's perceptions of whether, how, why, and for whom their abortion attitudes may have changed over their life course. We qualitatively investigated the reasons (e.g., experiences, life events) that triggered changes in respondents' abortion attitudes and quantitatively explored the sociodemographic factors associated with the perceived direction of those changes. The quantitative data come from a 2020 online survey completed by 1501 English and Spanish-speaking adults in the US. Qualitative data were collected from a subsample (n = 24) of the survey respondents who indicated interest in a follow-up in-depth interview. Our findings indicate that access to information and knowledge played an important role in changing abortion attitudes across a spectrum of support or opposition. For those who indicated becoming more opposed to abortion over time, experiencing parenthood was an important trigger for change and family/religious upbringing were key to shaping attitudes. For those who became more supportive of abortion over time, empathy for women was an important trigger for change and disagreeing with or distancing oneself from family/religious upbringing were key to shaping their attitudes. If attitudinal change occurs, becoming more supportive of abortion over the life-course is more common than becoming more opposed, however there are some nuances across age and gender. Understanding the different factors that influence attitudinal change regarding abortion has important implications for public opinion research and possible ramifications for abortion legality.

The Effects of Aberrant Responding on Model-Fit Assuming Different Underlying Response Processes.

Aberrant responding on tests and surveys has been shown to affect the psychometric properties of scales and the statistical analyses from the use of those scales in cumulative model contexts. This study extends prior research by comparing the effects of four types of aberrant responding on model fit in both cumulative and ideal point model contexts using graded partial credit (GPCM) and generalized graded unfolding (GGUM) models. When fitting models to data, model misfit can be both a function of misspecification and aberrant responding. Results demonstrate how varying levels of aberrant data can severely impact model fit for both cumulative and ideal point data. Specifically, longstring responses have a stronger impact on dimensionality for both ideal point and cumulative data, while random responding tends to have the most negative impact on data model fit according to information criteria (AIC, BIC). The results also indicate that ideal point data models such as GGUM may be able to fit cumulative data as well as the cumulative model itself (GPCM), whereas cumulative data models may not provide sufficient model fit for data simulated using an ideal point model.

People's knowledge of and attitudes toward abortion laws before and after the Dobbs v. Jackson decision.

Although media response to the Dobbs v. Jackson Women's Health Organization decision was widespread in the United States, the extent to which people were aware of the Mississippi law leading to the decision, the Dobbs v. Jackson case, is unclear, as are the resulting effects of the decision on legal abortion. As such, we examined people's awareness of abortion legality prior to and after the Dobbs v. Jackson decision announcement, as well as the potential implications associated with the decision (i.e. overturning of Roe v. Wade). We also examined people's attitudes toward abortion legality, specifically focusing on 15 weeks' gestation to correspond with the Mississippi law that led to Dobbs v. Jackson. Data were collected across two studies at different times. In Study 1, a 15-minute survey was administered to IPSOS' KnowledgePanel (N = 1014) prior to the decision announcement. A shorter version of that survey was administered to a second sample using NORC's AmeriSpeak Omnibus panel (N = 1002). Nearly half of that sample (42.2%) completed the survey prior to the decision announcement. People were generally unaware of the Mississippi law, the Dobbs v. Jackson case, and implications associated with the decision (e.g. overturning Roe v. Wade). People generally endorsed abortion being legal at 15 weeks or later, but this varied by circumstance. We did not find meaningful effects of the decision announcement on people's knowledge and attitudes. Our findings suggest that the intense response to the decision from the media and people involved in the abortion movement may not represent the general public's reaction.

Perceptions of abortion access across the United States prior to the Dobbs v. Jackson Women's Health Organization decision: Results from a national survey.

CONTEXT: Abortion is common in the United States (US), although access is becoming more difficult for some. In addition to restrictive policies that ban most abortion, limit the number of providers and increase costs, barriers to access also include less supportive cultural climates and stigma related to abortion. Prior to the Dobbs v. Jackson Women's Health decision of the United States Supreme Court, research suggested that people generally believed it was easy to access abortion, but this research did not examine the underlying factors that drive these perceptions. METHODS: In 2019, using data from closed and open-ended survey questions, we examined differences in people's assessment of abortion access within the state they reside and factors that influence those perceptions. We recruited English- and Spanish-speaking US adults (N = 2599) from Qualtrics' national panel using quota-based sampling to participate in a web-based survey. We used multinomial logistic regression to examine predictors of access perceptions across demographic characteristics and thematic analysis to analyze open-ended responses. RESULTS: Fifty-three percent of participants believed abortion was easy to access in their state. Spanish speakers and participants from legislatively "hostile" states were more likely to perceive access as difficult. Legality-related knowledge and pro-life identity were associated with perceiving abortion access as easy. CONCLUSIONS: Prior to Dobbs, participants' interpretation of the ease or difficulty of accessing abortion were subjective. Misconceptions about state abortion laws and the prevalence of providers were common, suggesting a need for more education about abortion laws, policies, and access.

A Mixed-Methods Approach to Understanding the Disconnection between Perceptions of Abortion Acceptability and Support for Roe v. Wade among US Adults.

The relationship between people's attitudes about abortion acceptability and the Supreme Court decision in Roe v. Wade-two distinct but related issues-has not been rigorously explored. The authors used a mixed-methods approach for analyzing in-depth interviews to better understand how participants' feelings toward abortion acceptability are related to perceptions of whether abortion should be legal. The authors then assessed (1) correlations between abortion acceptability and different measures of support for Roe v. Wade, and (2) how the phrasing of survey items related to Roe v. Wade may evoke different responses via an online survey fielded in 2018. The study's qualitative results highlight that there is a disjuncture between people's moral feelings toward abortion and their attitudes toward abortion legality. The study's quantitative results further demonstrate that correlations between abortion acceptability and support for Roe v. Wade are moderate, and the differences in responses to the phrasing of survey items related to Roe v. Wade are moderated by knowledge. The authors recommend that when researchers develop survey items, they avoid ambiguities of abortion as a general construct, especially when public opinion measures on abortion are employed for research and the design of social and health policy and practice.

Reliability and Validity of the 30-15 Intermittent Field Test With and Without a Soccer Ball.

Objective: The purpose of this study was to examine the reliability and validity of the 30-15 Intermittent Field Test (30-15IFT) with and without a ball. Methods: Twenty-four collegiate female soccer players (19.46 ± 1.22 years; 167.01 ± 7.23 cm; 60.95 ± 7.84 kg) performed 1 trial of the Yo-Yo Intermittent Recovery (YYIR) test, 3 trials of the 30-15IFT, and 3 trials of the 30-15IFT with a ball (30-15IFT-B), separated by a minimum 48 hours. Maximal intermittent running velocity (VIFT), heart rate at exhaustion (HRpeak), and rating of perceived exertion (RPE) were collected. Results: Intraclass correlation coefficients (ICCs) between trials demonstrated good reliability during the 30-15IFT in VIFT (ICC = 0.88) and HRpeak (ICC = 0.89), in addition to the 30-15IFT-B VIFT (ICC = 0.83) and HRpeak (ICC = 0.87). VIFT was significantly reduced in 30-15IFT-B (15.82 km h-1) compared to 30-15IFT (17.52 km h-1; p < .001), regardless of trial. HR and RPE were significantly greater in 30-15IFT compared to 30-15IFT-B (p < .05). Estimated maximal oxygen consumption (VO2max) YYIR and estimated VO2max of 30-15IFT and 30-15IFT-B was very strongly (r = 0.82) and strongly (r = 0.68) correlated. Conclusion: The 30-15IFT is considered valid and reliable and the 30-15IFT-B was reliable in female soccer players.

A Genome-Wide Association Study of Prediabetes Status Change.

We conducted the first genome-wide association study of prediabetes status change (to diabetes or normal glycaemia) among 900 White participants of the Atherosclerosis Risk in Communities (ARIC) study. Single nucleotide polymorphism (SNP)-based analysis was performed by logistic regression models, controlling for age, gender, body mass index, and the first 3 genetic principal components. Gene-based analysis was conducted by combining SNP-based p values using effective Chi-square test method. Promising SNPs (p < 1×10-5) and genes (p < 1×10-4) were further evaluated for replication among 514 White participants of the Framingham Heart Study (FHS). To accommodate familial correlations, generalized estimation equation models were applied for SNP-based analyses in the FHS. Analysis results across ARIC and FHS were combined using inverse-variance-weighted meta-analysis method for SNPs and Fisher's method for genes. We robustly identified 5 novel genes that are associated with prediabetes status change using gene-based analyses, including SGCZ (ARIC p = 9.93×10-6, FHS p = 2.00×10-3, Meta p = 3.72×10-7) at 8p22, HPSE2 (ARIC p = 8.26×10-19, FHS p = 5.85×10-3, Meta p < 8.26×10-19) at 10q24.2, ADGRA1 (ARIC p = 1.34×10-5, FHS p = 1.13×10-3, Meta p = 2.88×10-7) at 10q26.3, GLB1L3 (ARIC p = 3.71×10-6, FHS p = 4.51×10-3, Meta p = 3.16×10-7) at 11q25, and PCSK6 (ARIC p = 6.51×10-6, FHS p = 1.10×10-2, Meta p = 1.25×10-6) at 15q26.3. eQTL analysis indicated that these genes were highly expressed in tissues related to diabetes development. However, we were not able to identify any novel locus in single SNP-based analysis. Future large scale genomic studies of prediabetes status change are warranted.

Assessing rigid modes of thinking in self-declared abortion ideology: natural language processing insights from an online pilot qualitative study on abortion attitudes.

INTRODUCTION: Although much work has been done on US abortion ideology, less is known relative to the psychological processes that distinguish personal abortion beliefs or how those beliefs are communicated to others. As part of a forthcoming probability-based sampling designed study on US abortion climate, we piloted a study with a controlled sample to determine whether psychological indicators guiding abortion beliefs can be meaningfully extracted from qualitative interviews using natural language processing (NLP) substring matching. Of particular interest to this study is the presence of cognitive distortions-markers of rigid thinking-spoken during interviews and how cognitive distortion frequency may be tied to rigid, or firm, abortion beliefs. METHODS: We ran qualitative interview transcripts against two lexicons. The first lexicon, the cognitive distortion schemata (CDS), was applied to identify cognitive distortion n-grams (a series of words) embedded within the qualitative interviews. The second lexicon, the Linguistic Inquiry Word Count (LIWC), was applied to extract other psychological indicators, including the degrees of (1) analytic thinking, (2) emotional reasoning, (3) authenticity, and (4) clout. RESULTS: People with polarized abortion views (i.e., strongly supportive of or opposed to abortion) had the highest observed usage of CDS n-grams, scored highest on authenticity, and lowest on analytic thinking. By contrast, people with moderate or uncertain abortion views (i.e., people holding more complex or nuanced views of abortion) spoke with the least CDS n-grams and scored slightly higher on analytic thinking. DISCUSSION AND CONCLUSION: Our findings suggest people communicate about abortion differently depending on their personal abortion ideology. Those with strong abortion views may be more likely to communicate with authoritative words and patterns of words indicative of cognitive distortions-or limited complexity in belief systems. Those with moderate views are more likely to speak in conflicting terms and patterns of words that are flexible and open to change-or high complexity in belief systems. These findings suggest it is possible to extract psychological indicators with NLP from qualitative interviews about abortion. Findings from this study will help refine our protocol ahead of full-study launch.

Abortion vs. Sexual Assault: People's Perceptions of Kavanaugh's Nomination to the Supreme Court of the United States.

Public reaction to Brett Kavanaugh's nomination to the Supreme Court of the United States initially centered around abortion. However, approximately two months after the nomination, sexual assault accusations against Kavanaugh were made public. We examined the extent that people's perceptions of Kavanaugh's stance on abortion and people's attitudes toward whether Kavanaugh committed sexual assault were associated with perceptions of Kavanaugh as a good Supreme Court justice. Data were collected from English- and Spanish-speaking participants (N = 2,883) in the United States via Qualtrics' panel. Using an exploratory hierarchical regression approach, we found that people's perceptions of whether Kavanaugh committed sexual assault was a stronger predictor of their attitudes toward Kavanaugh's quality as a Supreme Court justice [F(1,2855) = 1736.54, p < .001] than people's perceptions of him regarding abortion, after controlling for demographic characteristics and participants' abortion identity (e.g., identifying as pro-life, pro-choice). That sexual assault was a stronger predictor could suggest the importance of sexual assault regarding opinions of Supreme Court justices or potential over inflation of abortion as a salient issue. Researchers should investigate the saliency of sexual and reproductive health issues in relation to Supreme Court nominees.

FEASibility testing a randomized controlled trial of an exercise program to improve cognition for T2DM patients (the FEAST trial): A study protocol.

While cognitive dysfunction is an important concern in persons with type 2 diabetes mellitus (T2DM), it has received little attention in the T2DM literature. Although it often remains unrecognized, cognitive dysfunction associated with T2DM can lead to severe consequences. Prior research studies have consistently shown that aerobic exercise enhances cognitive function among healthy subjects. However, very few studies have examined the effects of aerobic exercise on cognitive function in persons with T2DM. In addition, one important single-nucleotide polymorphism that influences cognition in humans is the brain-derived neurotrophic factor (BDNF) Val66Met variant. Despite strong evidence suggesting aerobic exercise has a beneficial effect on cognitive function, there is significant variability in individual response to exercise programs on cognitive outcomes among Val/Val versus Met carriers. However, the evidence on how the BDNF Val66Met variant influences cognitive outcomes following an aerobic exercise intervention among individuals with T2DM is currently lacking. Therefore, the purpose of this randomized controlled trial is to pilot-test a 3-month supervised exercise program to improve plasma BDNF levels and cognition, overall and according to genotypes of the BDNF Val66Met variant. A total of 81 patients with T2DM will be randomly assigned to either aerobic exercise group (n = 54) or attention control group (n = 27) for 3 months. Outcomes of interest include postintervention changes in plasma BDNF levels, fasting blood glucose, hemoglobin A1c, body mass index, executive function, memory, and processing speed. This study will provide further evidence on use of exercise as a non-pharmaceutical, low-cost intervention to improve cognition in this population.

Translation frameworks and questionnaire design approaches as a component of health research and practice: A discussion and taxonomy of popular translation frameworks and questionnaire design approaches.

Multilanguage surveys are a vital component of comparative public health science. And, with dozens of tools available to guide the translation and design process, an open dialogue about key translation frameworks and design approaches and their strengths and limitations is needed. Herein, we briefly summarize the application and use of several popular translation frameworks and questionnaire design approaches. Our purpose is to draw attention to the complexities of multilanguage surveys by noting how the most appropriate framework or approach is entirely dependent on the context of a specific study. We conclude with a call encouraging the adoption of frameworks and approaches that value high degrees of cultural input, ideally among a large team of culture, language, and subject matter experts. And, as the implemented translation framework or questionnaire design approach may hold implications for the quality and validity of data, we also call on editors to create recommendations that encourage disclosure of the translation framework(s) and/or questionnaire design approaches guiding multilanguage surveys.

Applicability of a Salient Belief Elicitation to Measure Abortion Beliefs.

Objectives: Salient belief elicitations (SBEs), informed by the Reasoned Action Approach (RAA), are used to identify 3 sets of beliefs - behavioral, control, and normative - that influence attitudes toward a health behavior. SBEs ask participants about their own beliefs through open-ended questions. We adapted a SBE by focusing on abortion, which is infrequently examined through SBEs; we also included a survey version that asked participants their views on what a hypothetical woman would do if contemplating an abortion. Given these deviations from traditional SBEs, the purpose of this study was to assess if the adapted SBE was understood by participants in English and Spanish through cognitive interviewing. Methods: We examined participants' interpretations of SBE items about abortion to determine if they aligned with the corresponding RAA construct. We administered SBE surveys and conducted cognitive interviews with US adults in both English and Spanish. Results: Participants comprehended the SBE questions as intended. Participants' interpretations of most questions were also in line with the respective RAA construct. Conclusions: SBE survey questions were comprehended well by participants. We discuss areas in which SBE questions can be modified to improve alignment with the underlying RAA construct to assess abortion beliefs.

The Influence of the BDNF Val66Met Polymorphism on the Association of Regular Physical Activity With Cognition Among Individuals With Diabetes.

INTRODUCTION: Diabetes is associated with cognitive dysfunction that comes with substantial lifetime consequences, such as interference with diabetes self-management and reduced quality of life. Although regular physical activity has been consistently shown to enhance cognitive function among healthy subjects, significant interpersonal differences in exercise-induced cognitive outcomes have been reported among brain-derived neurotrophic factor (BDNF) Val/Val vs. Met carriers. However, the evidence on how the BDNF Val66Met variant influences the relationship between regular physical activity and cognition among individuals with diabetes is currently lacking. METHODS: A total of 3,040 individuals with diabetes were included in this analysis using data from the Health and Retirement Study. Associations among moderate and vigorous physical activities (MVPA) and measures of cognitive function were evaluated using multivariable linear regression models within each stratum of the Val66Met genotypes. RESULTS: MVPA was more strongly associated with total cognitive score, mental status, and words recall among Met/Met carriers, compared to Val/Val and Val/Met carriers. CONCLUSIONS: This study provided preliminary findings on how BDNF variants may modulate the exercise-induced cognitive benefits among mid-aged and older adults with diabetes. Given the limitations of the current study, it is necessary for randomized controlled trials to stratify by BDNF genotypes to more conclusively determine whether Met carriers benefit more from increased physical activity. In addition, future research is needed to examine how the interplay of BDNF Val66Met variants, DNA methylation, and physical activity may have an impact on cognitive function among adults with diabetes.

Hepatic alterations during the development and progression of cancer cachexia.

Cancer-associated bodyweight loss (cachexia) is a hallmark of many cancers and is associated with decreased quality of life and increased mortality. Hepatic function can dramatically influence whole-body energy expenditure and may therefore significantly influence whole-body health during cancer progression. The purpose of this study was to examine alterations in markers of hepatic metabolism and physiology during cachexia progression. Male C57BL/6J mice were injected with 1 × 106 Lewis Lung Carcinoma cells dissolved in 100 µL PBS and cancer was allowed to develop for 1, 2, 3, or 4 weeks. Control animals were injected with an equal volume of phosphate-buffered saline. Livers were analyzed for measures of metabolism, collagen deposition, protein turnover, and mitochondrial quality. Animals at 4 weeks had ∼30% larger livers compared with all other groups. Cancer progression was associated with altered regulators of fat metabolism. Additionally, longer duration of cancer development was associated with ∼3-fold increased regulators of collagen deposition as well as phenotypic collagen content, suggesting increased liver fibrosis. Mitochondrial quality control regulators appeared to be altered before any phenotypic alterations to collagen deposition. While induction of Akt was noted, downstream markers of protein synthesis were not altered. In conclusions, cancer cachexia progression is associated with hepatic pathologies, specifically liver fibrosis. Alterations to mitochondrial quality control mechanisms appear to precede this fibrotic phenotype, potentially suggesting mitochondrial mechanisms for the development of hepatic pathologies during the development and progression of cancer cachexia. Novelty Cachexia progression results in liver collagen deposition and fibrosis. Alterations in mitochondrial quality control may precede liver pathologies during cachexia.

College Student E-cigarette Use: A Reasoned Action Approach Measure Development.

Objectives: The purpose of this study was to develop and validate an instrument using the reasoned action approach (RAA) to measure recreational electronic cigarette (e-cigarette) use among college students. Methods: Using a multi-phase, cross-sectional design, a 32-item measure was developed, and the factor structure was explored and confirmed using an exploratory factor analysis (EFA; N = 369) and confirmatory factor analysis (CFA; N = 320), respectively. An exploratory structural equation model (ESEM) and SEM also were employed to examine the relationships between latent constructs and to test the application of the RAA. Results: After removing 9 items, the EFA identified 3 RAA constructs (intention, attitude, social norms), and the ESEM established moderate model fit. The CFA confirmed the 3 factors; however, acceptable model fit was not met until a global social norm variable was loaded onto injunctive and descriptive norms. Based on this 5-factor solution, attitudes (ß = .35, p < .001) and social norms (ß = .50, p <.001) significantly predicted intention to use e-cigarettes. Conclusions: Attitudes and social norms influence college students' intention to use e-cigarettes and should be addressed via health education messaging and prevention programs.

Nurse practitioners' time on nonbillable activities.

BACKGROUND AND PURPOSE: During the provision of patient care delivery, all providers, including nurse practitioners (NPs), spend some time in activities that are not reimbursable. Understanding these nonbillable activities is crucial to the economic viability and success of existing and projected practice models. This study explored and compared seven nonbillable activities occurring in the practices of NPs in various settings. METHODS: Using a nonexperimental, descriptive design, 509 NPs were surveyed about nonbillable activities encountered in daily practice. Binomial regression analyses and incidence rate ratios were used to interpret relationships between each variable and nonbillable time. CONCLUSIONS: Although not every variable had significance, there were significant differences found in the amount of time spent in certain nonbillable activities depending on workplace setting, number of support staff, and primary care provider role. IMPLICATIONS FOR PRACTICE: The uncertainty of health care reform, including reimbursement, provider shortage, and the expanding roles of NPs, requires a closer look at both billable and nonbillable care activities. Understanding how nonbillable time affects work efficiency, costs, and the value of NPs will allow NPs to influence future health care reimbursement policies and delivery care models.

Are Women's Orgasms Hindered by Phallocentric Imperatives?

Women who have sex with women (WSW) are more likely to report experiencing an orgasm during partnered sex, compared to women who have sex with men (WSM). We investigated whether this difference can be partially accounted for by phallocentric imperatives-gendered sexual scripts that prioritize men's sexual experience. For example, these imperatives emphasize vaginal-penile intercourse (i.e., the coital imperative) and men's physical pleasure (i.e., the male orgasm imperative). We reasoned that a larger variety of sexual behaviors indicates less adherence to the coital imperative and that more self-oriented orgasm goals for women indicate less adherence to the male orgasm imperative. Consistent with previous work, we expected WSW to report higher rates of orgasm than WSM when taking frequency of sex into account. We also hypothesized that this difference in orgasm rates would dissipate when controlling for variety of sexual behavior and women's self-oriented orgasm goals. In a sample of 1988 WSM and 308 WSW, we found that WSW were 1.33 times (p < .001) more likely to report experiencing an orgasm than WSM, controlling for frequency of sex. This incidence rate ratio was reduced to 1.16 (p < .001) after taking into account variety of sexual behavior and self-oriented orgasm goals. Our findings indicate that certain sexual scripts (e.g., phallocentric imperatives) help explain the orgasm discrepancy between WSW and WSM. We discuss masturbation as another male-centered practice that may be relevant to this gap, as well as implications for intervention and future research.

Beyond "Just Saying No": A Preliminary Evaluation of Strategies College Students Use to Refuse Sexual Activity.

Preventing sexual assault is a core goal for universities as prevalence rates of sexual assault remain high, particularly among college students. A key mechanism thought to decrease rates of sexual assault is teaching college students how to give clear, explicit, verbal refusals. However, there is a paucity of research regarding how college students refuse sex. Thus, the purpose of this study was to understand different behavioral strategies college students would use to refuse sex. A sample of 773 heterosexual college students (523 women, 250 men) were recruited from two large southern universities in the USA to complete a survey on sexual communication. Thirty-eight items assessing verbal and behavioral cues that college students would use to refuse vaginal-penile sex were written based on previous, formative research. Items were assessed by the research team through an exploratory factor analyses, followed by a confirmatory factor analysis (CFA). The results yielded a three-factor structure: direct nonverbal refusals, direct verbal refusals, and indirect nonverbal refusals; CFA results suggested a good fit index for the model. Two independent sample t tests were conducted to examine differences in refusal cues across gender and relationship status; significant differences in refusals emerged for both. The three-factor structure depicting refusal cues was similar to previous work depicting cues college students use to communicate sexual consent; such information could inform sexual assault prevention programming.

The Southern states: NPs made an impact in rural and healthcare shortage areas.

PURPOSE: To investigate the distribution of nurse practitioners (NPs) in the U.S. Southern region with a focus on rural and underserved areas. Described in this study are the NP characteristics and their workforce distribution relative to rural and health professional shortage areas (HPSAs). METHOD: A questionnaire was administered to NPs in 12 Southern states. Other data sources included (a) the Health Resources and Services Administration, which identified HPSAs; and (b) data from the U.S. Census Bureau, to distinguish urban and rural areas. CONCLUSIONS: Approximately 72% of NPs worked in HPSAs and less than half of the NPs worked in the rural area. Family NPs were more likely to practice in rural and HPSAs. Employment in primary care was more likely to occur in rural and HPSAs. Racial diversity was almost nonexistent within the NP population. IMPLICATION FOR PRACTICE: This research does demonstrate that NPs are practicing in rural and underserved areas as conceived decades ago, but there is still a great demand and gap to fill. To optimize their effectiveness, NPs need to practice to the full extent of their education. Additionally, more research and strategies to help diversify the workforce is needed.