Geographic Variation in Cesarean Sections in the United States: Trends, Correlates, and Other Interesting Facts.

Analyzing data spanning three decades covering the near universe of births, we study county-level differences in Cesarean section (C-section) rates among first-time mothers of singleton births. Our research reveals persistent geographic variation in C-section rates for both low- and high-risk groups. Counties with elevated C-section rates consistently perform more C-sections across mothers at all levels of appropriateness for the procedure. These elevated rates of C-section in high C-section counties are associated with reduced maternal and infant morbidity. We also find that C-section decisions are less responsive to underlying risks for Black mothers relative to white mothers, suggesting potential welfare-reducing disparities.

Five-Year Program Evaluation of an Evidence-Based Practice Scholars Program.

The purpose of this article is to describe the findings of a 5-year program evaluation of a hospital-based Evidence-Based Practice (EBP) Scholars Program. The EBP Scholars Program was developed in 2011 to (a) educate and engage staff in the EBP process and (b) develop a cadre of EBP mentors within each clinical unit of the organization. The evaluation of the EBP Scholars Program examined both the feasibility and the impact of the program. The findings suggest that not only is the program feasible to implement and highly acceptable to the participants, but it also significantly increases staff EBP self-efficacy and promotes staff engagement in EBP, organizational leadership, and professional development. Most importantly, this program has been foundational to motivating and sustaining a strong culture of inquiry at our Magnet® designated organization. [J Contin Educ Nurs. 2018;49(12):547-554.].

The limits of simple implementation intentions: Evidence from a field experiment on making plans to exercise.

Recent large-scale randomized experiments find that helping people form implementation intentions by asking when and where they plan to act increases one-time actions, such as vaccinations, preventative screenings and voting. We investigate the effect of a simple scalable planning intervention on a repeated behavior using a randomized design involving 877 subjects at a private gym. Subjects were randomized into i) a treatment group who selected the days and times they intended to attend the gym over the next two weeks or ii) a control group who instead recorded their days of exercise in the prior two weeks. In contrast to recent studies, we find that the planning intervention did not have a positive effect on behavior. We observe a tightly estimated null effect even though the majority of subjects believed that planning is helpful and despite clear evidence that they engaged with the planning process.

Can financial incentives help people trying to establish new habits? Experimental evidence with new gym members.

Can financial incentives aid habit formation in people attempting to establish a positive health behavior? We provide evidence on this question from a randomized controlled trial of modest-sized incentives to attend the gym among new members of a fitness facility. Our experiment randomized 690 participants into a control group that received a $30 payment unconditionally or one of 3 incentive groups that received a payment for attending the gym at least 9 times over the first 6 weeks of membership. Two incentive treatment arms offered monetary payments of $30 and $60. The third incentive treatment, motivated by the endowment effect, offered a physical item worth $30. All three incentives had only small impacts on attendance during members' first 6 weeks and no effect on their post-incentive visit trajectories. We document substantial overconfidence among new members about their likely visits and discuss how overconfidence may undermine the effectiveness of incentive programs.

Nurses' concerns about caring for patients with acute and chronic traumatic brain injury.

AIMS AND OBJECTIVES: As a first step in developing traumatic brain injury-specific nursing education, the purpose of this study was to investigate nurses' concerns about caring for patients with moderate-to-severe traumatic brain injury. BACKGROUND: Patients with moderate-to-severe traumatic brain injury typically have significant immediate and chronic cognitive impairments. These cognitive impairments can negatively affect their inpatient stay after an acute traumatic brain injury and affect their health care later in life when seeking care for other acute health conditions during the chronic phase of traumatic brain injury. Nurses must be knowledgeable about modifying care to accommodate the cognitive impairments of these patients throughout the continuum of care. Yet, current guidelines focus exclusively on acute care and do not address nurses' central role in dealing with residual cognitive impairments of these patients. Thus, educational and training interventions are needed to ensure nurses have adequate knowledge to care for these patients. DESIGN: We conducted a cross-sectional, exploratory survey of 692 nurses across hospital departments at three hospitals between October 2014-August 2015. Nurses answered the following qualitative open-ended question: "What are your primary concerns about providing care to patients with moderate-to-severe traumatic brain injury?" METHODS: Conventional qualitative content analysis was used to analyse nurses' responses. RESULTS: Findings showed nurses reported multiple concerns about caring for patients in the acute phase after traumatic brain injury, but few concerns about caring for patients in the chronic phase. Some of the concerns nurses reported included: (i) preventing physical injury; (ii) missing changes in condition; (iii) providing adequate education; (iv) providing support; and (v) promoting recovery. Barriers to providing adequate care were as follows: (i) lack of knowledge; (ii) limited staffing; and (iii) inadequate resources. CONCLUSIONS: Findings have implications for education of nurses and development of nursing guidelines for management of patients with traumatic brain injury, including providing direction for nurses on development of care plans for patients in the chronic phase after a moderate-to-severe traumatic brain injury.

Building capacity for the conduct of nursing research at a Veterans Administration hospital.

Evidence is the bedrock of nursing practice, and nursing research is the key source for this evidence. In this article, we draw distinctions between the use and the conduct of nursing research and provide a perspective for how the conduct of nursing research in a Veterans Administration hospital can build an organization's capacity for nursing research.

Evaluation of a Curriculum to Improve Clinician Communication With Adolescents.

INTRODUCTION: While guidelines for health care clinicians working with adolescent patients encourage open communication and confidential visits, current practices often fall short and many adolescents do not receive confidential care or adequate communication about sexually transmitted infections, reproductive health, and other sensitive health topics. METHODS: The Providers and Teens Communicating for Health (PATCH) program in Wisconsin aims to bridge communication gaps between adolescents and health care clinicians. Teen educators are hired and trained to lead 2 types of workshops-one targeting peers and one targeting clinicians. RESULTS: Pre- and post-intervention evaluations show improvements in clinician and teen knowledge, intentions to seek and provide quality care, and reported change in care delivery. CONCLUSION: The PATCH program curriculum shows promise for improving the care of young people throughout Wisconsin.

The importance of parental knowledge: evidence from weight report cards in Mexico.

The rise of childhood obesity in less developed countries is often overlooked. We study the impact of body weight report cards in Mexico. The report cards increased parental knowledge and shifted parental attitudes about children's weight. We observe no meaningful changes in parental behaviors or children's body mass index. Interestingly, parents of children in the most obese classrooms were less likely to report that their obese child weighed too much relative to those in the least obese classrooms. As obesity rates increase, reference points for appropriate body weights may rise, making it more difficult to lower obesity rates.

Young women's reasons to seek sexually transmitted infection screening.

OBJECTIVES: To describe young women's reasons to seek and not to seek sexually transmitted infection (STI) screening; to explore whether reasons differed by age and STI screening history. DESIGN AND SAMPLE: Cross-sectional, descriptive. Female students (N = 216) at a university in the Midwestern United States. MEASURES: An anonymous online survey was designed based on the Theory of Care Seeking Behavior and literature regarding STI screening among young women. RESULTS: The most common reason to seek STI screening was to start treatment promptly (85%); the most common reason not to seek screening was being asymptomatic (54%). Participants' reasons differed by age and screening history. Women under 25 were more likely than women 25 and older to seek screening because of encouragement from female role models (p < .01). Women who had never been screened were more likely than women who had been screened to avoid screening because of embarrassment (p < .05). Novel findings included seeking STI screening because it "should be done" if sexually active and because of encouragement from female role models. CONCLUSIONS: Health care and public health professionals can use these findings to develop strategies to improve STI screening rates among young women.

Formative research for the development of an interactive web-based sexually transmitted disease management intervention for young women.

Sexually transmitted diseases are common among young women and effective self-management is foundational to improving health outcomes and preventing negative sequelae. Advances in technology create the opportunity for innovative delivery methods of self-management interventions. However, it is essential to conduct formative research with the target population to identify both the needs and the preferences for the content and delivery method of a sexually transmitted disease self-management intervention prior to intervention development. Eight focus groups were conducted with 35 young women between 18 and 24 years of age. We found that young women strongly support the use of a Web-based intervention to provide sexually transmitted disease self-management guidance. Women were interested in receiving comprehensive management information from the perspective of both clinicians and other women who have experienced a sexually transmitted disease. There was a clear interest in incorporating new media into the Web-based intervention to allow for communication with providers as well as to create opportunities for social networking between women. This formative research provides critical information about the content and delivery method of a self-management intervention and gives direction for intervention development that is inclusive of varying types of new media to allow for connectivity among users, their peers, and clinicians.

Sexually transmitted disease testing misconceptions threaten the validity of self-reported testing history.

OBJECTIVE: Sexually transmitted disease (STD) testing is fundamental to STD prevention and control. We sought to comprehensively examine young women's beliefs about the STD testing process. DESIGN AND SAMPLE: Descriptive, cross-sectional, survey investigation. Women aged 18-24 (n = 302) drawn from four women's health clinics and one university classroom. MEASURES: Participants completed the RoTEST, which measures five domains of women's STD testing beliefs and a demographic survey. RESULTS: Many women believed they would be screened for all STDs when they receive STD testing (40%) and that visual inspection by a provider was a valid method of STD screening for gonorrhea (35%), chlamydia (32%) and HSV (77%). More than a quarter believed that a Pap test screens for gonorrhea (23%) and chlamydia (26%). Twenty-one percent reported that discussing STD testing with a provider is difficult and most reported feeling more comfortable seeking STD testing from an STD specialist rather than a family doctor (79%). CONCLUSIONS: Young women have numerous misconceptions about the STD testing process that may interfere with the validity of their self-reported STD testing history and subsequently undermine public health efforts to improve STD prevention and control. Innovative approaches to educating women about the testing process are needed.

Genital herpes beliefs: implications for sexual health.

STUDY OBJECTIVE: Genital herpes (HSV) is exceedingly common in the United States and women are disproportionally affected. This study aims to describe young women's beliefs about HSV and examine the correlates of those beliefs. DESIGN: A 40-item Herpes Representation measure (HSV-RoSTD) and a demographic questionnaire were administered to a convenience sample of young women. Data analysis included descriptive statistics, t-tests and Pearson's correlations. SETTING: Four women's health clinics and one large state university. PARTICIPANTS: 302 women aged 18-24 years. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Four dimensions of HSV representations (cause, identity, future perspective, and psychosocial consequences), age and STD testing history. RESULTS: Nearly all (98%) believed that HSV would result in genital sores and 68% believed they could tell if their sexual partner had HSV. Most (89%) understood the longevity of HSV; however, 30% believed that they could take a pill to get rid of the infection, and 15% indicated that it was likely they would die from HSV. Negative beliefs about the psychosocial impact of HSV were common as 95% indicated they would be depressed and 90% indicated concern about sex and partner notification. Those who were younger and those who had never been tested for STDs believed a genital herpes infection is highly symptomatic. Finally, negative beliefs about the psychosocial consequences of HSV were associated with beliefs about HSV being symptomatic, having a negative impact on future health, and being associated with sexual risk behaviors. CONCLUSIONS: Young women have misconceptions about HSV, particularly regarding the symptomatology and the role of HSV medication. Noteworthy concerns about the negative psychosocial consequences of an HSV diagnosis were also raised, all of which have implications for young women's sexual health.

The Effect of Education on Adult Mortality and Health: Evidence from Britain.

There is a strong, positive, and well-documented correlation between education and health outcomes. In this paper, we attempt to understand to what extent this relationship is causal. Our approach exploits two changes to British compulsory schooling laws that generated sharp across-cohort differences in educational attainment. Using regression discontinuity methods, we find the reforms did not affect health although the reforms impacted educational attainment and wages. Our results suggest caution as to the likely health returns to educational interventions focused on increasing educational attainment among those at risk of dropping out of high school, a target of recent health policy efforts.

Young women's beliefs regarding human papillomavirus.

OBJECTIVE: To describe young women's perceptions of human papillomavirus (HPV) using the Common Sense Model and examine whether perceptions differ based on history of HPV diagnosis or sexually transmitted disease (STD) testing. DESIGN: Cross-sectional, survey data. SETTING: Four women's health clinics and one university classroom. PARTICIPANTS: Three hundred and two women ages 18-24. METHODS: Young women's beliefs regarding HPV were measured using the HPV Representations of Sexually Transmitted Diseases (RoSTD) survey. RESULTS: Most survey respondents believed HPV diagnosis was likely to result in cancer and death. Negative beliefs about the psychosocial consequences of HPV diagnosis were common. Compared to those who had not been diagnosed with HPV (or had never received STD testing), young women with a history of HPV diagnosis or STD testing had less serious and more accurate beliefs about HPV. CONCLUSION: Young women tend to have misconceptions about HPV in addition to noteworthy concerns about the psychosocial consequences of HPV diagnosis. Clinical attention to young women's beliefs about HPV may provide direction for improving the delivery of patient-centered education and counseling about this exceedingly common illness.

Young women's Representations of Sexually Transmitted Diseases (RoSTD): a psychometric study.

Measurement of beliefs about sexually transmitted diseases (STDs) is important to understanding sexual health behaviors. The purpose of this study was to develop and test the psychometric properties of the Representations of STDs (RoSTD) Scale. The RoSTD was developed to measure young women's representations of STDs, and it is intended to be used to measure beliefs about any of the seven most common STDs. Confirmatory factor analysis indicated a four-factor structure for the 40-item RoSTD: Future Perspective, Cause, Psychosocial Consequence, and Identity. Internal consistency for the subscales (measured for each of seven different STDs) ranged from .67 to .93 and 2-week test-retest correlations ranged from .69 to .90. The RoSTD shows evidence of reliability and validity in young women.

The Effect of Female Education on Fertility and Infant Health: Evidence from School Entry Policies Using Exact Date of Birth.

This paper uses age-at-school-entry policies to identify the effect of female education on fertility and infant health. We focus on sharp contrasts in schooling, fertility, and infant health between women born just before and after the school entry date. School entry policies affect female education and the quality of a woman's mate and have generally small, but possibly heterogeneous, effects on fertility and infant health. We argue that school entry policies manipulate primarily the education of young women at risk of dropping out of school.

Sexpectations: male college students' views about displayed sexual references on females' social networking web sites.

STUDY OBJECTIVE: Sexual reference display on a social networking web site (SNS) is associated with self-reported sexual intention; females are more likely to display sexually explicit content on SNSs. The purpose of this study was to investigate male college students' views towards sexual references displayed on publicly available SNSs by females. DESIGN: Focus groups. SETTING: One large state university. PARTICIPANTS: Male college students age 18-23. INTERVENTIONS: All tape recorded discussion was fully transcribed, then discussed to determine thematic consensus. MAIN OUTCOME MEASURES: A trained male facilitator asked participants about views on sexual references displayed on SNSs by female peers and showed examples of sexual references from female's SNS profiles to facilitate discussion. RESULTS: A total of 28 heterosexual male participants participated in seven focus groups. Nearly all participants reported using Facebook to evaluate potential female partners. Three themes emerged from our data. First, participants reported that displays of sexual references on social networking web sites increased sexual expectations. Second, sexual reference display decreased interest in pursuing a dating relationship. Third, SNS data was acknowledged as imperfect but valuable. CONCLUSION: Females who display sexual references on publicly available SNS profiles may be influencing potential partners' sexual expectations and dating intentions. Future research should examine females' motivations and beliefs about displaying such references and educate women about the potential impact of these sexual displays.

Young women's beliefs about the terms sexually transmitted disease and sexually transmitted infection.

OBJECTIVE: To determine whether young women differentiate between the terms sexually transmitted disease and sexually transmitted infection and if they do whether their reasons are consistent with those of health care providers. DESIGN: Secondary analysis of cross-sectional, survey data. SETTING: Four women's health clinics and one university classroom. PATIENT/PARTICIPANTS: Three hundred and two women aged 18 to 24. METHODS: The women completed a survey that measured beliefs about seven sexually transmitted diseases, a demographic and sexually transmitted disease health information questionnaire, and a single item assessing whether the terms sexually transmitted disease and sexually transmitted infection were interchangeable. RESULTS: Fifty-seven percent (n=155) responded that sexually transmitted disease and sexually transmitted infection do not mean the same thing, 28% (n=76) responded that sexually transmitted disease and sexually transmitted infection mean the same thing, and 15% (n=42) responded they do not know. Beliefs about sexually transmitted disease stigma and symptoms were not related to sexually transmitted disease terminology; beliefs about curability were related but not in the hypothesized direction. CONCLUSIONS: A majority of the young women do differentiate between the terms sexually transmitted disease and sexually transmitted infection; however, the rationale for doing so is not consistent with the rationale used by health care providers. Professionals should clarify their use of the terms sexually transmitted disease and sexually transmitted infection when talking with patients as a means to improve health communication and subsequently improve sexually transmitted disease health care.