Identification with and Social Comparison to Teen Mothers on Teen Mom Over Time.

This study replicates from a cross-sectional study about how young Latina teen viewers identify with and socially compare to teen mothers on MTV's Teen Mom over time. Identification and social comparison effects on attitudes toward teen pregnancy were assessed among the same group of Latina teen viewers at two different time points approximately one year apart. Results determined that upward social comparison and identification were associated with positive attitudes toward teen pregnancy in eighth grade, whereas downward social comparison was associated with negative attitudes toward teen pregnancy in ninth grade. Implications for teen mom reality programming audiences are discussed.

Analyzing the Cost of Hospital Contact Isolation Practices: Implications for Nursing Administrator Practice, Research, and Policy.

OBJECTIVES: This study aimed to determine the weekly costs of contact precaution (CP) use with medically stable patients infected/colonized with methicillin-resistant Staphylococcus aureus (MRSA) and to estimate the annual financial and environmental costs of CP. BACKGROUND: The increasing use of disposables for infection control contributes to increasing hospital costs and amounts of solid waste at rates that are becoming unsustainable. METHODS: A cost analysis was conducted using data from time/motion observations and previous waste audit study, along with hospital finance department values and US Department of Labor salary rates. RESULTS: Weekly and annual costs were $521.67 and $557 463 (5% hospital multidrug-resistant organism [MDRO] rate assumed). Personal protective equipment accounted for 43% of the waste produced (approximately 1600 pounds annually). CONCLUSIONS: Implications for nurse administrators include reevaluating activities that require personal protective equipment (PPE) and partnering with materials and human factor engineers to develop more financially and environmentally sustainable infection control practices.

Hispanic Mother-Daughter Communication About the Risks of Sex, Drugs, and Alcohol: Influences and the Strategies Mothers Use.

PURPOSE: U.S. Hispanic adolescents are at risk for negative health outcomes due to risk-taking behaviors involving sex, drugs, and alcohol. Mother-daughter communication can reduce these risk-taking behaviors and reinforce parents' expectations. The purpose of this study was to explore mothers' descriptions of their communication about risk-taking behaviors with their early adolescent Hispanic daughters. DESIGN AND METHODS: This qualitative descriptive study involved focus groups with 21 Hispanic mothers of 7th grade (12-14 years old) girls. Conventional content analysis was conducted to identify the strategies they used during these conversations. RESULTS: Strategies mothers used included warning, focusing on negative consequences, creating opportunities to express maternal expectations, and stressing the importance of positive influences. Communication was also influenced by daughters' physical development and social media. CONCLUSIONS: The mothers were concerned about their daughters' exposure to risk-taking behaviors but were unsure about how to talk to their daughters about how to avoid them, particularly regarding topics related to sex. PRACTICE IMPLICATIONS: Our study results have implications on how to facilitate parent-child conversations about risk-taking behaviors and to equip mothers and parents to teach their children how to avoid engaging in these behaviors.

Parent Communication and Bullying Among Hispanic Adolescent Girls.

In this article, we report findings regarding parent communication and daughter's experiences of bullying and victimization in a sample of Hispanic families with seventh-grade daughters. About 57% of daughters reported experiencing any form of victimization and 37% reported engaging in some type of bullying behavior. Overall, the most common type of victimization reported was verbal/emotional bullying (36%). Nearly all parents agreed they had spoken with their daughters about the dangers of bullying perpetration (95%) and how to handle being victimized (96%), but there was no association between the frequency with which parents spoke with their daughters about bullying perpetration and their child's victimization experiences. Additionally, the gap between parent and child acculturation did not appear to moderate this association. The high incidence of self-reported bullying perpetration and victimization experiences underscores the need for school nurses, parents, and school personnel to address bullying behavior.

Implementation Quality: Implications for Intervention and Translational Science.

PURPOSE: Implementation quality (IQ), a critical concept for translational science, measures the discrepancy between an intervention's intended design and its implementation. Quantifying the impact of IQ on intervention outcomes informs efforts to improve intervention translatability. The purpose of this article is to define and describe IQ and its dimensions (content adherence, quality of delivery, and engagement) with a focus on individualized interventions being delivered in research and practice settings. APPROACH: We apply IQ concepts from intervention science in two contexts: (a) an intervention currently being investigated in an efficacy trial, and (b) a practice situation involving the application of evidence-based practice guidelines during clinic visits. IQ measurement approaches are presented using a study protocol, progress notes, interdisciplinary meeting notes, or clinical guidelines, depending upon whether the intervention is delivered during a research study or a clinical encounter. CONCLUSIONS: The investigators describe the necessary infrastructure and support for capturing IQ data and the subsequent complexities and challenges of collecting, measuring, and analyzing these data. Understanding IQ is critical to advancing translational science. Such understanding informs application of appropriate IQ measures, and promotes effective translation of evidence-based interventions into practice. Policy changes are needed to promote IQ assessment to ensure high-quality clinical encounters during which interventions are effectively delivered. CLINICAL RELEVANCE: In both research and practice settings, the conceptualization and measurement of IQ will improve patient outcomes by advancing translational science and integrating evidence-based interventions into nursing practice.

Improving the Care of Patients with Chronic Kidney Disease Using Group Visits: A Pilot Study to Reflect an Emphasis on the Patients Rather Than the Disease.

This two-group, repeated-measures experimental study assessed the efficacy of a nurse practitioner-facilitated chronic kidney disease (CKD) group visit (GV) model versus usual nephrology care for patients with Stage 4 CKD. The study enrolled patients from two sites of an outpatient nephrology practice (n = 30) and randomized subjects to usual care (n = 14) or to the GV model (n = 16). Data regarding CKD knowledge, self-efficacy/disease self-management, and physiologic measures were collected at baseline, 6 months, and 9 months. Satisfaction was obtained at 6 months and 9 months. Usual nephrology office visit components were maintained during six monthly GVs, with group discussions of CKD-related topies. Results indicated a statistical improvement in CKD knowledge for both groups (F[1.498, 34.446] = 6.363, p = 0.008). An upward trend in mean scores for self-management subscales and self-efficacy scores was demonstrated in the GV patients, with no improvement found in the usual care group. Twenty-six of 30 patients completed the study, with 92% attendance in the GV group. GV satisfaction was high.

Resisting pressure from peers to engage in sexual behavior: What communication strategies do early adolescent Latino Girls use?

A content analysis of early adolescent (M=12.02 years) Latino girls' (n=44) responses to open-ended questions imbedded in an electronic survey was conducted to explore strategies girls may use to resist peer pressure with respect to sexual behavior. Analysis yielded 341 codable response units, 74% of which were consistent with the REAL typology (i.e., refuse, explain, avoid, and leave) previously identified in adolescent substance use research. However, strategies reflecting a lack of resistance (11%) and inconsistency with communication competence (e.g., aggression, involving authorities) were also noted (15%). Frequency of particular strategies varied according to offer type, suggesting a variety of strategies may be needed to resist the peer pressure that puts early adolescent girls at risk for engaging in sexual behavior. Findings argue for universality of the REAL typology, building communication competence skills for conflict resolution in dating situations, and including peer resistance strategies in adolescent pregnancy prevention programs.

Narrative and Behavioral Engagement as Indicators for the Effectiveness of Intentionally Designed Virtual Simulations of Interpersonal Interactions.

Interventions involving simulated interactions aimed at mimicking real situations must be engaging to maximize their effectiveness. This study aimed to assess how a sample of middle school girls displayed behavioral and cognitive indicators of engagement when interacting with avatars representing game characters that were controlled by a human digital puppeteer. The simulation game, DRAMA-RAMA, is a component of an intervention intended to reduce at-risk girls' sexual and other risky behaviors. We used verbal/nonverbal behaviors and surveys to assess the game players' cognitive and behavioral involvement (N = 131). Participants perceived the game scenarios and interactions as realistic and the characters as similar to people in real life. Participants' behavior indicated their involvement and interest in interacting with the game characters. Finally, participants tended to be appropriate but not effective when attempting to advise/support the characters. These findings have implications for assessing successful operationalization of communication designs in interactive virtual learning environments.

Randomized trial of a peer resistance skill-building game for Hispanic early adolescent girls.

BACKGROUND: Adolescents can use peer resistance skills to avoid being pressured into risky behavior, such as early sexual behavior. Avatar-based virtual reality technology offers a novel way to help build these skills. OBJECTIVES: The aims of this study were to evaluate the feasibility of an avatar-based virtual reality peer resistance skill building game (DRAMA-RAMA), to explore the impact of game play on peer resistance self-efficacy, and to assess how positively the game was perceived. METHODS: Forty-four low-income early adolescent Hispanic girls were assigned randomly to either the intervention (DRAMA-RAMA) or attention control game (Wii Dancing With the Stars) condition. All participants were offered a five-session curriculum that included peer resistance skill content before playing their respective game for 15 minutes, once a week, for 2 weeks. Participants completed electronic surveys at baseline, after game play, and at 2 months to assess demographics, peer resistance self-efficacy, and sexual behavior. They also completed a paper-pencil game experience questionnaire immediately after game play. Data were analyzed using descriptive statistics, t test, chi-square, and analyses of covariance. RESULTS: Separate analyses of covariance showed a significant game effect at posttest for the peer resistance self-efficacy measure (F = 4.21, p < .05), but not at follow-up (F = 0.01, p = .92). DRAMA-RAMA was rated as positively as the Wii Dancing With the Stars (p > .26). DISCUSSION: This randomized control trial provides preliminary support for the hypothesis that playing an avatar-based virtual reality technology game can strengthen peer resistance skills, and early adolescent Hispanic girls will have a positive response to this game.

Infección de Amor (Infectious Love): Development and Acceptability of a Telenovela/Soap Opera Intervention for HIV Prevention For Latinas.

Latinas continue to be disproportionately affected by HIV in the United States. Effective interventions to address HIV-related disparities among Latinas are available; however, they have not achieved widespread dissemination due to implementation challenges for real-world settings. A culturally tailored intervention that increases access to HIV prevention is urgently needed. The objective of this study was to develop a culturally tailored telenovela (i.e., a soap opera) to promote HIV prevention behaviors (condom use; HIV testing; and pre-exposure prophylaxis awareness, access, and use) among Latinas. The study was conducted in community organizations throughout South Florida. A total of 44 Spanish-speaking Latinas, 18-35 years old, and sexually active with a man in the past 6 months participated in the study. The final product was an HIV prevention telenovela that incorporated Latinas' ideas and feedback and was produced as four 10-minute filmed episodes. This study aimed to develop innovative approaches to reduce HIV-related disparities for Latinas.

Interactive performance and focus groups with adolescents: the power of play.

Conducting focus groups with adolescents can be challenging given their developmental needs, particularly with sensitive topics. These challenges include intense need for peer approval, declining social trust, short attention span, and reliance on concrete operations thinking. In this article, we describe an adaptation of interactive performance as an alternative to traditional focus group method. We used this method in a study of discrimination experienced by Muslims (ages 13-17) and of peer pressure to engage in sexual behavior experienced by Hispanic girls (ages 10-14). Recommendations for use of this method include using an interdisciplinary team, planning for large amounts of disclosure towards the end of the focus group, and considering the fit of this method to the study topic.

The Measurement of Female Early Adolescent Sexual Desire.

We used the developmental systems model to deduce a definition of female early adolescent sexual desire. We evaluated a measure of this phenomenon with a secondary analysis of data from a randomized group sexual health intervention trial involving low-income, English-speaking, seventh grade Latinas enrolled in a Miami-Dade County public school (n = 542). As part of this study, girls completed a four-item early adolescent sexual desire (EASD) measure. Study findings supported internal consistency (Cronbach's alpha = .81 to .82) and stability over a 1-month period (r = .74). Developmental sensitivity was supported by a decline in stability over 12- (r = .66) and 24-month periods (r = .56). Validity was supported by correlations with puberty changes, sexual intentions, sexting, and sexual behavior, and hypothesized mean differences associated with dating and preference for shoes culturally associated with female sexual attractiveness (p < .01). Research implications include validation work with other ethnic/racial groups and using the EASD as a starting point for a measurement continuum tracking development of sexual desire across adolescence and into adulthood. Directions for future research also include measuring the development of sexual desire in boys and transgendered youth across adolescence and into adulthood.

Cultural Influences on Hispanic Mother-Daughter Communication About Sex.

INTRODUCTION: Hispanic adolescents are at high risk of engaging in sexual risk-taking behaviors. Parent-child communication protects against such behaviors. Among Hispanic families, it is critical to explore how cultural characteristics influence mothers-daughter communication about sex. The purpose of this qualitative study was to understand how cultural values influence mothers' communication about sex with their early adolescent Hispanic daughters. METHODOLOGY: Twenty-one Hispanic mothers of seventh-grade daughters participated in this focus group study. Directed content analysis was used to analyze the data. RESULTS: Four Hispanic cultural values (familismo, machismo, marianismo, and respeto) and how each value influences mother-daughter communication about sex were identified. While mothers want to protect their daughters, there are multiple cultural norms that made it challenging for them to have critical conversations. DISCUSSION: The study informs researchers and clinicians how to facilitate parent-child conversations about sex and to equip parents to teach their children how to avoid engaging in sexual risk-taking behaviors.

Examining factors that increase and decrease stress in adolescent community college students.

In contrast to adolescents attending traditional universities, adolescents attending community colleges represent a large but relatively unstudied population with respect to stress and mental health issues. The purpose of this study was to determine what factors increase and decrease stress in a sample of adolescent community college students (N = 166). Findings from a self-administered questionnaire indicated that students had moderate levels of stress and resilience. Contrary to predictions, males demonstrated statistically significant higher levels of stress than females, but as expected, resilience had a significant negative effect on stress (p < .05). Practice and research implications are discussed for nurses in pediatric settings.

Premigration persecution, postmigration stressors and resources, and postmigration mental health: a study of severely traumatized U.S. Arab immigrant women.

BACKGROUND: Competing theories exist regarding the importance of premigration trauma as compared with postmigration stressors and resources with respect to the risk to immigrant mental health. OBJECTIVE: To examine how type of premigration trauma, postmigration stressors, and postmigration resources differentially predict posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) symptomatology in Arab immigrant women who have been exposed to premigration trauma. DESIGN: Descriptive, using multinomial logistic regression to explain membership in one of four groups: (a) PTSD only (n = 14), (b) MDD (n = 162), (c) comorbid PTSD-MDD (n = 148), and (d) subclinical symptoms (n = 209). RESULTS: Parameter estimates for postimmigration-related stressors (as measured by the Demands of Immigration [DI]) indicated that a unit increase in DI scores was associated with a nearly 16-fold increase in the likelihood of being in the comorbid relative to the subclinical group, and a nearly 2.5-fold increase in the likelihood of being in the comorbid relative to the MDD-only group (p < .05). Odds ratios for social support, age, and type of premigration trauma ranged between 0.95 and 1.95 and only differentiated between subclinical and comorbid PTSD-MDD groups (p < .05). CONCLUSION: Postmigration stressors exert substantive effects on immigrant mental health outcomes. Nursing interventions are needed to reduce immigration-related stressors. Screening Arab immigrant women for depression and PTSD is important, given the high levels observed in this community-based sample.

Multicultural Adaptation of Mighty Girls for Widespread Dissemination: Pilot Study, App Development and Usability Testing, and Gauging Parent Support With Focus Groups.

BACKGROUND: Taking evidence-based interventions to scale is a challenge for prevention science. Mighty Girls is an evidence-based sexual health intervention program that combines classroom sessions with novel, cutting-edge technology (digital puppetry). The program was developed for 7th grade Latinas, but US school and community demographics rarely allow interventions targeting a single ethnic group. Additionally, digital puppetry is costly to scale up, and parent disapproval often prevents successful dissemination of adolescent sexual health programs. Intervening steps along the scaling-up pathway are needed to adapt the program prior to scaling up for dissemination. OBJECTIVE: The aims of this study were to create a multicultural adaptation of the Mighty Girls program using a mobile app that is less costly to disseminate and is acceptable to parents of 7th grade girls. METHODS: This study used a three-phase process to adapt Mighty Girls into Mighty Teens. All phases used purposive (nonprobability) sampling of low-income, multicultural, urban metropolitan groups (7th grade girls and their parents) within central Florida. Phase 1 involved two videotaped implementations of a multicultural adaptation of the classroom sessions, one involving focus groups (N=14) and the other serving as a single-group pretest-posttest pilot study (N=23). Phase 2 involved development of a narrative cell phone app prototype, which was subjected to usability testing (N=25). App usability and engagement were assessed qualitatively (observation, focus group, open-ended questions) and quantitatively. Phase 3 used focus groups to assess parent support for the program (N=6). Qualitative data were analyzed using descriptive content analysis. Quantitative data were analyzed using descriptive statistics and paired t tests. RESULTS: Qualitative findings supported classroom sessions being multicultural, and identified simple changes to improve engagement and learning. Quantitative findings from the second classroom session implementation pilot study indicated a significant pre-post difference in intention to delay sexual intercourse (P=.04). App usability and appeal were supported by a System Usability Scale score of 76 (exceeding 68 per the industry standard) and 83% (20/24) of participants agreeing they would recommend the app to friends. Parents (mothers) expressed only positive regard for program goals, and classroom session and app activities. CONCLUSIONS: This study adapted Mighty Girls into an engaging, easier-to-disseminate, multicultural program, termed Mighty Teens, that uses a narrative-generating app to support behavior change, and is likely to be accepted by parents of 7th grade girls. This study also provides evidence of the preliminary effectiveness of Mighty Teens classroom sessions. The sampling method and sample size were appropriate for adaptation, but research involving a more representative US sample is needed to confirm multicultural fit, parent receptivity, and program effectiveness. Study implications include integrating app use throughout the classroom sessions to build narrative-generating skills across the program and increasing the number of narratives produced, which should in turn increase the program's behavior change potency.

Teen Dating Violence and Suicide Risk Among Bisexual Adolescents.

PURPOSE: Suicide is a public health problem that disproportionately affects bisexual youth more than heterosexual, lesbian/gay, and other sexual minority youth. Teen dating violence (TDV) consists of physically, emotionally, and/or psychologically aggressive behavior in adolescent relationships and has been linked to increased suicidality among sexual minority youth. Although biological sex differences in suicide and TDV have been noted, limited research currently exists regarding the importance of these differences in bisexual youth. METHODS: This study employed a cross-sectional descriptive design to investigate the relationship between biological sex, TDV, and suicide risk among bisexual youth in grades 9-12. This study used structural equation modeling to conduct a secondary analysis of pooled 2015 and 2017 national Youth Risk Behavior Surveillance Survey data that examined whether TDV mediated the relationship between biological sex and suicide risk among bisexual youth. RESULTS: Results indicated that TDV did not mediate the relationship between biological sex and suicide risk among bisexual youth. Biological sex was a significant predictor of suicide risk with male youth reporting lower suicide risk than female youth, when controlling for dating history, TDV, age, and race. TDV predicted suicide risk, with youth reporting TDV having higher suicide risk, when controlling for dating history, biological sex, age, and race. In addition, black and Hispanic youth reported lower suicide risk compared to white youth. CONCLUSION: There is a dire need for research that addresses issues of TDV and suicide among bisexual youth. Understanding factors influencing suicide risk following TDV experiences among bisexual youth will inform interventions to mitigate negative mental health outcomes.

Latina Teens' Identification with and Social Comparison to Mothers on Teen Mom.

A survey was conducted with low income Latina teens (M = 13.31 years of age) to examine the ways in which exposure, identification with, and social comparison to teen mothers featured on the MTV program Teen Mom influenced attitudes toward teen pregnancy. Analyses revealed that those who identified with and looked up to the teen mothers on Teen Mom were less likely to think getting pregnant would be embarrassing, a terrible event, or prevent them from achieving their dreams. The identification and upward social comparison processes observed here extend those observed in previous research across ethnic, income, and cultural differences. Implications regarding the potentially negative effects of portrayals of teen motherhood on Teen Mom are discussed.

Assessing reliability and validity of the Arabic language version of the Post-traumatic Diagnostic Scale (PDS) symptom items.

Arab immigrant women are vulnerable to post-traumatic stress disorder (PTSD) because of gender, higher probability of being exposed to war-related violence, traditional cultural values, and immigration stressors. A valid and reliable screen is needed to assess PTSD incidence in this population. This study evaluated the reliability and validity of an Arabic language version of the symptom items in Foa et al.'s [Foa, E.B., Cashman, L., Jaycox, L., and Perry, K. 1997. The validation of a self report measure of posttraumatic stress disorder: the Posttraumatic Diagnostic Scale. Psychological Assessment 9(4), 445-451]. Post-traumatic Diagnostic Scale (PDS) in a sample of Arab immigrant women (n=453). Reliability was supported by Cronbach's alpha values for the Arabic language version (0.93) and its subscales (0.77-0.91). Results of group comparisons supported validity: Women who had lived in a refugee camp or emigrated from Iraq - a country where exposure to war and torture is common - were exhibiting depressive symptoms (Center for Epidemiological Studies-Depression Scale (CES-D) score above 18), or reported moderately to severely impaired functioning had significantly higher mean PDS total and symptom subscale scores than women who had not had these experiences or were not exhibiting depressive symptoms. Scores on the PDS and its subscales were also positively correlated with the Profile of Mood States (POMS) depression and anxiety subscales and negatively correlated with the POMS vigor subscale (r=-.29 to-.39).

Avoidance symptoms and assessment of posttraumatic stress disorder in Arab immigrant women.

This study investigates whether the avoidance symptom criterion required for a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV; American Psychiatric Association, 1994) diagnosis of posttraumatic stress disorder (PTSD) is overly conservative. Arab immigrant women (N = 453), many of whom reported experiencing multiple traumatic events, completed the Posttraumatic Diagnostic Scale in Arabic as part of a face to face interview. Analyses indicated all but one avoidance symptom was reported less frequently than reexperiencing and arousal symptoms. However, those who fully met reexperiencing, avoidance, and arousal symptom criteria had worse symptom severity and functioning than those who fully met reexperiencing and arousal symptom criteria, but only partially met avoidance symptom criterion. Study findings support importance of the PTSD avoidance symptom criterion.