Promoting Healthy Eating Among African-American School-Aged Girls in a Community Setting.

The prevention of obesity is vital to the health of American children. In the urban African-American community, the health of school-aged children is in particular jeopardy due to the high prevalence of obesity, type 2 diabetes, and poor dietary choices such as the purchase of sugary drinks, salty snacks, low consumption of fresh fruits and vegetables, and reliance on fast food meals. African-American girls are at a higher risk for obesity and early puberty before age 10, placing them at a greater risk for diabetes and cardiovascular disease in adulthood. Our current "Cooking with Kids" program in a local grocery store has allowed us to promote healthy eating behavior in a unique way; teaching 6 through 11-year-olds how to prepare easy healthy breakfasts, lunches, and snack food recipes at a local grocery store while their mothers shopped.

Comparing Online with Face-to-Face HELPP Intervention in Women Experiencing Intimate Partner Violence.

Intimate partner violence (IPV) is a public health problem. The purpose of this study was to compare the effectiveness of the HELPP (Health, Education on Safety, and Legal Support and Resources in IPV Participant Preferred) intervention among IPV survivors. A sequential, transformative mixed-methods design was used. Participants were randomly assigned to one of three study groups: Online (ONL), Face-to-Face (FTF), and Waitlist Control (WLC). The HELPP intervention was offered to 32 adult female participants who were 45.2% Asian, 32.3% White, and 22.5% Black. Outcome measures were anxiety, depression, anger, personal, and social support. In total, 64% (n  =  20) of the participants reported having experienced IPV before the age of 18. The anger mean score pre-test to post-test difference was significant for ONL (p < 0.001) and WLC (p  =  0.01). The personal and social support pre-test to post-test mean score differences were significant for ONL (p < 0.001; p < 0.001) and WLC (p  =  0.01; p  =  0.006), respectively. The HELPP intervention (1) decreased anxiety, depression, anger, and (2) increased personal and social support in the ONL group. The HELPP information and intervention was shown to be feasible, acceptable, and effective among IPV survivors compared with participants in the WLC group. The WLC participants displayed (1) increased levels of anxiety, depression, and anger and (2) decreased levels of personal and social support, post-intervention. Further research could be conducted to determine if e-mail alone or e-mail plus mobile devices are more useful modes of delivering interventions.

A Qualitative Exploration of Self-Advocacy Experiences of Black Women in the Perinatal Period: Who Is Listening?

INTRODUCTION: Black women face poor maternal health outcomes including being over 3 times more likely to die from pregnancy complications than White women. Yet the lived experience of how these women self-advocate has not been clearly explored. The goal of this cross-sectional qualitative study was to describe the lived experiences of Black women advocating for their needs and priorities during the perinatal period. METHODS: Between January and October of 2022, we recruited Black women from obstetric clinics, research registries, and community advocacy groups who were either in their third trimester of pregnancy or within a year postpartum. Participants completed one-on-one interviews describing their experiences of self-advocacy. These data were analyzed using descriptive content analysis approaches that summarized women's experiences by iteratively creating major themes and subthemes that encapsulate their self-advocacy descriptions. RESULTS: Fifteen Black women completed interviews. Major themes and subthemes describing women's experience of self-advocacy were the following: (1) carrying a burden with subthemes of having to be good and easy, not trusting health care information and providers, and being dismissed; (2) building comfort with health care providers with subthemes of trusting I have a good provider, comfort in knowing they understand, and wanting low-touch, high-concern care; and (3) advocating for my child and myself when I need to with subthemes of going with the flow, becoming informed, pushing to ask questions, and balancing being proactive and pushy. DISCUSSION: Women reported self-advocating mainly due to experiences related to the burdens associated with not trusting providers and health care information. These findings provide clarity to how women carefully balance between ensuring their health is taken seriously while not jeopardizing their health or that of their newborn. This study offers promising directions to support Black women in advocating for their perinatal health care needs and values.

Testing the theory of reasoned action in explaining sexual behavior among African American young teen girls.

This study tested the Theory of Reasoned Action to examine the prediction of early sexual behavior among African American young teen girls. Baseline data from a longitudinal randomized clinical trial were used. Between 2001 and 2005, 198 middle-school girls aged 11 to 14 years were recruited. As girls aged, they held more permissive attitudes toward engaging in early sexual behavior and had a higher intention to engage in early sexual behavior. Intention was a significant predictor to explain sexual behavior among the girls. There is a need to develop strategies that promote intention related to delay and prevention of early sexual behavior.

Evaluating the mental health of Jordanian women in relationships with intimate partner abuse.

This study evaluated the mental health consequences of abuse among Jordanian women and tested the effectiveness of using cognitive behavioral interventions to change the level of depression and level of stress among Jordanian women experiencing intimate partner abuse (IPA). A mixed methods design using phenomenology and quasi-experimental research data collection and analysis was implemented. The most commonly reported form of abuse was psychological abuse. Prior to cognitive behavioral intervention, participants demonstrated moderate to severe levels of depression, low levels of perceived social support, moderate to high levels of self-efficacy, and used approach coping skills more frequently than avoidance coping. Cognitive behavioral interventions resulted in decreased depression (p = .003) and decreased stress levels, although this finding did not reach significance (p > .05). Cognitive behavioral interventions are effective interventions when working with women experiencing IPA.

Tales from the "hood:" placing reproductive health communication between African American fathers and children in context.

OBJECTIVE: To evaluate reproductive health communication between African American fathers and their children. DESIGN: In this qualitative ethnographic study, data were collected through tape-recorded individual interviews about the content and timing of reproductive health communication, the reproductive health values fathers intended to impart to their children, and their comfort level in doing so. SAMPLE: A total sample of 19 African-American fathers participated. MEASUREMENTS: Data were coded according to the qualitative analytic principles established by Miles and Huberman (1994), and analyzed using manifest and latent content analysis approaches. RESULTS: Although 10 fathers reported feeling uncomfortable having these conversations, 18 reported having reproductive health communication with their children, and most encouraged their sons and daughters to delay sex until adulthood. These conversations were primarily driven by the fear of HIV/AIDS and the negative consequences of sex; however, some conversations were inappropriate for developmental age. CONCLUSIONS: African-American fathers may benefit from education to help them have age appropriate reproductive health communication with their children. Registered Nurses and Nurse Practitioners are well positioned to educate African American adolescents and their fathers on reproductive health. Future dyadic African American father-child studies are needed to explore more fully African-American children's perceptions of reproductive health communication and the effect on delaying sex.

Exploring the Experiences, Challenges, and Approaches of Parish Nurses in Their Community Practice.

PURPOSE: To explore the personal experiences, challenges, and practices of parish nurses in their communities. METHOD/DESIGN: The overall study used a mixed methods concurrent embedded design to describe parish nurses' experiences with diabetes education and preconception counseling in their practice. Also included were descriptions of generalized practices. Therefore, this current report will focus on these broader experiences. Focus group data were collected using face-to-face, teleconference, and video conferencing formats with 48 nurses who consider themselves to be parish nurses and analyzed with content analysis. FINDINGS: Four qualitative themes were identified in the data: (1) Gaining Entry Through Trust, (2) Enhanced Focus on Spiritual Caring, (3) Accomplishing Much Despite Challenges, and (4) Practice Making a Difference. Parish nurses are uniquely situated to provide holistic care for the mind, body, and spirit of their patients. Despite the many positive aspects, parish nurses experience unique challenges, such as funding their practice and working independently. CONCLUSIONS: The parish nurses can play a vital role in providing holistic care to patients in a faith-based community. Future work is needed to address the challenges of parish nurses such as access to continuing education programs related to health topics of concern to their community members.

Exploring the Experience of African Immigrant Mothers Providing Reproductive Health Education to Their Daughters Aged 10 to 14 Years.

INTRODUCTION: Adolescents have disproportionate rates of unplanned pregnancies and sexually transmitted infections when compared with all other age groups. Mothers are gatekeepers and providers of reproductive health education, which can prevent teen pregnancy and sexually transmitted infections. Reproductive health education provided by African immigrant mothers is influenced by cultural experiences and cultural contexts that are not well understood and have not been studied. This study sought to describe the experience of African mothers living in the United States providing reproductive health education to their daughters aged 10 to 14 years. METHOD: A qualitative descriptive design was used. Twenty African immigrant mothers were interviewed in a community setting. Qualitative content analysis approach was used for analysis. RESULTS: Three main themes emerged: (1) mothers' reproductive health education in their country of origin, (2) mothers' reproductive health communication with their daughters, and (3) changes due to the move to the United States. DISCUSSION: Mothers believed daughters were too young for reproductive health education, leading to conversations with limited content that were frequently triggered by daughters' exposure to reproductive health education outside the home. IMPLICATIONS: African immigrant mothers may benefit from culturally congruent discussions with health care providers about the reproductive health information they give their daughters.

"Sex Will Make Your Fingers Grow Thin and Then You Die": The Interplay of Culture, Myths, and Taboos on African Immigrant Mothers' Perceptions of Reproductive Health Education with Their Daughters Aged 10-14 Years.

This paper examines the convergence of culture, myths, and taboos surrounding reproductive health issues African immigrant women, living in the United States, learned during childhood in their countries of origin. We also discuss how mothers' perceptions of reproductive health education (RHE) influenced the education of their own daughters aged 10-14 years. This was a qualitative descriptive study. Data were collected via interviews and demographic survey. The sample size was 20 African immigrant mothers living in a mid-sized city in the U.S. Interviews were transcribed verbatim. Qualitative data was analyzed using qualitative content analysis. Myths and taboos related to menstruation, sexual intercourse, pregnancy, and HIV/AIDS were reported by the women interviewed. Discussion of these issues was largely taboo, and most myths the mothers learned growing up pertained to sexual intercourse, pregnancy prevention, and pregnancy termination using non-hormonal ingested substances. Myths and taboos about sexual issues are widespread in Africa and are propagated to control sexual behavior, especially that of unmarried people, particularly women. By examining these myths and taboos, we are able to somewhat contextualize the mothers' immigrant experience regarding RHE. Although myths were reported, the majority of mothers did not appear to believe them. The most significant taboo reported was sexual intercourse. This in turn led to mothers' overemphasis on abstinence for their daughters. It is also noteworthy that this sample contained mainly African women who overall were highly educated, spoke English, and could adequately navigate life in the U.S. It is unclear what the results would be if we were to examine African immigrant women with less achievements in these areas.

Evaluating the Theory of Planned Behavior to explain intention to engage in premarital sex amongst Korean college students: a questionnaire survey.

BACKGROUND: To reduce risky adolescent sexual behavior, education programs must be tailored to specific cultures and stage of adolescence. OBJECTIVES: This study describes the self-reported sexual behavior of Korean college students and examines the efficiency of the Theory of Planned Behavior (TpB) in explaining intention of engaging in premarital sex in order to provide insights for a potential sex education program designed to reduce risky sexual behavior. DESIGN: A cross-sectional, correlational design using an exploratory survey method was used. PARTICIPANTS: Participants were recruited from a university in Korea with a flyer posted at the entrance of the student health service center, and self-referral in 2004. Male and female unmarried college students aged 18 to 25 were included. Foreign students and students with visible physical problems were excluded. Three hundred and twenty of 550 students returned the questionnaire packets. Final data analysis included 298 students after deleting incomplete data. METHODS: Participants completed six questionnaires: (1) Background and Sexual Behavior Questionnaire, including items related to perceived risk of sexual behavior, (2) Parent-Adolescent Communication Scale, and four scales related to TpB construct: (3) modified Premarital Sexual Attitude Scale, (4) Referent group Approval of Sex Behavior Scale, (5) Sexual Abstinence Efficacy Scale and (6) modified version of Doswell's Intention of Sexual Behavior Scale. RESULTS: Premarital sexual attitude, abstinence self-efficacy and referent group norms were significant predictors of intention of premarital sex for male students with a large effect, but only attitude and norms predicted intention of premarital sex for female students. CONCLUSION: The TpB may be an effective theory to guide the development of theory-driven sexual abstinence interventions to reduce risky sexual behavior for Korean males, while the Theory of Reasoned Action may be an effective theory for Korean females.

Experiences of Parish Nurses in Providing Diabetes Education and Preconception Counseling to Women With Diabetes.

OBJECTIVE: To explore the role and experiences of the parish nurse in providing diabetes education and preconception counseling to women with diabetes. DESIGN: Mixed-methods concurrent embedded design. SETTING: Focus groups of community-based parish nurses accessed from a regional database (Pennsylvania, Florida, Ohio, New York, Arizona, and Minnesota). PARTICIPANTS: Forty-eight parish nurses recruited from the Parish Nurse and Health Ministry Program database in Western Pennsylvania. METHODS: The primary method was focus groups using face-to-face, teleconference, and videoconferencing formats. A secondary method used a quantitative descriptive design with three self-report measures (demographic, preconception counseling self-efficacy, and preconception counseling knowledge). Qualitative content analysis techniques were conducted and combined with descriptive analysis. RESULTS: Forty-eight parish nurses participated in 1 of 11 focus groups. Eight qualitative themes emerged: Awareness, Experience, Formal Training, Usefulness, Willingness, Confidence, "Wise Women," and Preconception Counseling Tool for Patients. Participants provided recommendations for training and resources to increase their knowledge and skills. Parish nurses' knowledge scores were low (mean = 66%, range = 40%-100%) with only moderate levels of self-efficacy (mean = 99, range = 27-164). Self-efficacy had a significantly positive association with knowledge (r = .29, p = .05). CONCLUSION: Quantitative results were consistent with participants' qualitative statements. Parish nurses were unaware of preconception counseling and lacked knowledge and teaching self-efficacy as it related to preconception counseling and diabetes education. Understanding parish nurses' experiences with women with diabetes and identifying their needs to provide education and preconception counseling will help tailor training interventions that could affect maternal and fetal outcomes.

Attitudes and Beliefs of African Immigrant Mothers Living in the US Towards Providing Comprehensive Sex Education to Daughters Aged 12-17 Years: A Pilot Study.

The literature currently contains no comprehensive sex education (CSE) interventions targeting the African immigrant population. African immigrant mothers have been inhibited by several factors from providing their daughters with CSE. The primary aim of this study was to identify attitudes and beliefs of Sub-Saharan immigrant mothers living in the United States towards providing comprehensive sex education to their daughters aged 12-17 years. The study utilized a one-time anonymous nine-question survey. Fifteen women who met the inclusion criteria completed the study survey online or via paper format. African immigrant mothers are willing to allow comprehensive sex to be taught in schools and at home. Accepted education appears to range from religious and moral teaching to some factual information. This research will potentially assist in the designing of more culturally appropriate comprehensive sex education programs for African immigrant mothers and their daughters.

Spirituality moderates the relationship of psychosocial stress to metabolic risk factors among Afro-Caribbean immigrants in the US Virgin Islands.

OBJECTIVE: Spirituality may contribute to the health advantage of foreign-born blacks compared to United States (US)-born blacks. The objective of this study was to test the hypothesis that spirituality attenuates the association of psychosocial stress to stress-associated metabolic risk factors among foreign-born Caribbean blacks living in a US jurisdiction. METHODS: Data on demographic factors, anthropometric measurements (height, weight and waist), fasting glucose and insulin, lifestyle behaviors (smoking and alcohol use), psychosocial stress and spirituality were collected from a population-based sample of 319 Afro-Caribbean immigrants, ages 20 and older, who were recruited between 1995 and 2000 in the Virgin Islands of the United States (USVI). Glucose and insulin measurements were used to estimate insulin resistance by the homeostasis model assessment (HOMA-IR) method. Participants were classified into three levels of spirituality, "low", "medium" and "high" based on the distribution of spirituality scores. Stepwise regression analyses were used to identify the significant predictors of waist circumference and HOMA-IR within each level of spirituality. RESULTS: The predictors of waist circumference and HOMA-IR varied across the levels of spirituality. Psychosocial stress was an independent predictor of waist and HOMA-IR only among participants with a low level of spirituality. CONCLUSION: Spirituality appears to attenuate the association of psychosocial stress to waist circumference and insulin resistance among Afro-Caribbean immigrants in the USVI.

Risk-taking behaviors in early adolescent minority women: implications for research and practice.

Adolescence is a time of biologic, intellectual, and psychosocial transition for young women. For an African American or Hispanic girl, the challenge of being female is compounded by the challenge of being a member of a minority group. In this article, the authors present the reproductive health challenges faced by African American and Hispanic girls and suggest research-based programs and nursing practice interventions to address these challenges.

The NIA Group. Building a sense of purpose in preadolescent African American girls: a novel approach to nursing leadership in community health.

Many African American girls experience pubertal development early. Earlier pubertal development may place these girls at greater risk of exposure to or engagement in early sexual behavior. Young girls facing this societal context need interventions to help them develop healthy self-esteem, pride in their cultural heritage, good decision-making skills and a sense of purpose. It was from these concerns that the NIA Program of Self-Development for preadolescent girls was initiated as a collaboration of the University of Pittsburgh School of Nursing, a local public school, and the nursing staff of the Matilda Theiss Health Center, a comprehensive community health center that houses the NIA Group. The group's name, "NIA," meaning a sense of purpose, is derived from one of the seven principles of Kwanzaa, a yearly African American celebration of cultural heritage.

Another look at heterosocial behaviors: one side of the early intimate sexual behaviors coin.

The number of adolescent births is once again on the rise. Heterosocial competence described as successful interactions (i.e., heterosocial behaviors) with males (Grover, Nangler, & Zeff, 2005; Grover, Nangler, Serwik, & Zeff, 2007) is one emerging factor that has been found to be associated with adolescent sexual behavior. The aims of this cross sectional design study with 159 African American middle-school girls using the theory of reasoned action (Ajzen & Fishbein, 1980) were to describe and assess the relationship between heterosocial behaviors and sexual behaviors. Data was obtained using four surveys. The results suggest that heterosocial behaviors were a significant predictor of sexual behaviors (p < .001).

Implications of type 2 diabetes on adolescent reproductive health risk: an expert model.

PURPOSE: The purpose of this article was to summarize scientific knowledge from an expert panel on reproductive health among adolescents with type 2 diabetes (T2D). METHODS: Using a mental model approach, a panel of experts--representing perspectives on diabetes, adolescents, preconception counseling, and reproductive health--was convened to discuss reproductive health issues for female adolescents with T2D. RESULTS: Several critical issues emerged. Compared with adolescents with type 1 diabetes, (1) adolescents with T2D may perceive their disease as less severe and have less experience managing it, putting them at risk for complications; (2) T2D is more prevalent among African Americans, who may be less trusting of the medical establishment; (3) T2D is associated with obesity, and it is often difficult to change one's lifestyle within family environments practicing sedentary and dietary behaviors leading to obesity; (4) teens with T2D could be more fertile, because obesity is related to earlier puberty; (5) although obese teens with T2D have a higher risk of polycystic ovary syndrome, which is associated with infertility, treatment with metformin can increase fertility; and (6) women with type 2 diabetes are routinely transferred to insulin before or during pregnancy to allow more intensive management. CONCLUSIONS: Findings from the expert panel provide compelling reasons to provide early, developmentally appropriate, culturally sensitive preconception counseling for teens with T2D.