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Adolescents who engage in unprotected intercourse are at risk of pregnancy and sexually transmitted infection (STI). Although adolescents in rural areas participate in levels of sexual risk taking similar to that of nonrural youth, few data are available identifying factors that influence condom use among rural adolescents. The purpose of this study is to determine the predictive value of selected personal, environmental, and behavioral factors for condom use among rural adolescents in grades 9-12. A cross-sectional survey was conducted among sexually active youth ("N" = 613), ages 14-19, in three rural school districts in the Northeast. Using logistic regression, identified predictors for condom use include personal standards (odds ratio [OR] = 2.45; confidence interval [CI]: [2.39, 6.47]), condom use goals (OR = 1.32; CI [1.21, 1.45]), condom use at first intercourse (OR = 3.93; CI [2.39, 6.47]) and male gender. School nurses are encouraged to incorporate identified predictors of condom use when considering interventions promoting safer sexual behaviors among rural youth. (Contains 6 tables and 1 figure.)

Gestational diabetes mellitus is the most common complication of pregnancy and contributes to increased risk for type 2 diabetes in both the mother and offspring. We developed and evaluated a gestational diabetes risk reduction and preconception counseling program, Stopping GDM (SGDM), for American Indian females. The purpose of this study is to examine the experiences of American Indian mother-daughter dyad participants and the site coordinators who facilitated the SGDM randomized controlled trial to inform program revisions. We engaged mother-daughter dyads (n = 22 dyads) and site coordinators (n = 6) in focus group interviews. Four themes emerged: (1) SGDM sparked valuable quality conversation for dyads; (2) gestational diabetes risk factors and risk reduction was new information for most dyads; (3) all trial sites experienced challenges to recruitment and engagement; and (4) study-improvement recommendations. These findings will be used to enhance SGDM to decrease adverse intergenerational health impacts of gestational diabetes in American Indian communities. [ABSTRACT FROM AUTHOR]

The authors call for measures to protect recipients of lead-contaminated meat donated to U.S. food banks as a way to address the epidemic of lead poisoning in the country. Cited are how the contamination of hunted meat occurs, the risks of lead exposure to humans and wildlife posed by shooting lead ammunition into the environment, and the need of food safety standards for adulterated meat to prevent lead poisoning.

Throughout Nepal, women and girls follow a range of menstrual practices, many of which leave them vulnerable to negative health outcomes. We applied a participatory visual research method called Collaborative Filmmaking to acquire a nuanced and sensory understanding of menstrual practices and motivations in Kanchanpur, Nepal. The study also provides insight regarding menstrual practice complexities across different castes/ethnicities and religions. Results show an array of menstrual practices related to cleansing, cooking, touching, worshipping, and sleeping. Participants' menstrual practices varied by caste/ethnic and religious background and were motivated by religious and spiritual beliefs, family tradition, negative consequences, and social pressure. [ABSTRACT FROM AUTHOR]

Background: American Indian/Alaska Native (AI/AN) adolescents are at higher risk for gestational diabetes (GDM), type 2 diabetes, and pregnancy complications than the general population. Objective: To inform cultural adaptation of a validated evidence‐based intervention (VEBI) originally designed to deliver preconception counseling and diabetes education to non‐AI/AN teens with diabetes. Design Qualitative data were collected using focus group and individual interview methods with health care professionals and experts (n = 16) in AI/AN health, GDM, adolescent health, and/or mother‐daughter communication. A semistructured discussion guide elicited responses about provision of care for AI/AN girls at risk for GDM, experience with successful programs for AI/AN teens, comfort of mother/daughter dyads in talking about diabetes and reproductive health and reactions to video clips and booklet selections from the VEBI. All interviews were recorded and transcribed verbatim, and data analysis included inductive coding and identification of emergent themes. Results: Providers felt teens and their moms would be comfortable talking about the VEBI topics and that teens who did not feel comfortable talking to their mom would likely rely on another adult female. Participants suggested including: AI/AN images/motifs, education with a community focus, and avoiding directive language. Concerns included: socioeconomic issues that affect AI/AN people such as: food and housing insecurity, abuse, and historical trauma. Conclusions: Perspectives from these participants have been used to guide the development of a culturally tailored GDM risk reduction program for AI/AN girls. This program will be available to health care providers who serve the AI/AN population. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Purpose American Indian and Alaska Native (AIAN) women are disproportionately affected by gestational diabetes mellitus (GDM). GDM is a risk factor for subsequent diagnosis of type 2 diabetes (T2D) in both mother and offspring, yet there is minimal research being conducted in this population. The purpose of this portion of a larger 5-year study is to examine AIAN women's experiences of having GDM or T2D during pregnancy, inform the development of a GDM risk reduction and preconception counseling (PC) program tailored to AIAN girls, and enhance mother-daughter communication and support within the program. Methods AIAN women with TD2 or a history of GDM (N = 5) were interviewed to understand their unique perspectives on diabetes and pregnancy, behaviors to reduce risk, and content for a PC education program for AIAN girls. Interviews were digitally recorded, transcribed verbatim, and analyzed using the constant comparison method to construct themes across the interviews. Results Four primary themes were constructed: lack of knowledge on GDM and GDM risk factors, importance of AIAN culture for health and wellness, suggestions for communication with AIAN girls to reduce risk of GDM, and the emotional impact of GDM diagnosis. Conclusions Participants wished they had known about risk factors for GDM and how to reduce their own risk of developing GDM. Findings from this study have been used to adapt an existing PC program, originally developed for non-AIAN girls with diabetes, for AIAN girls who do not have diabetes but have risk factors for developing GDM in future pregnancies. [ABSTRACT FROM AUTHOR]

AbstractDespite current humanitarian efforts, The Rohingya in Bangladesh’s refugee camps have among the highest maternal mortality worldwide. The authors review maternal mortality within Rohingya refugee populations in Bangladesh, citing the camp conditions and cultural norms that affect the Maternal Mortality Ratio (MMR). Next, the authors review current humanitarian efforts made by the UNFPA toward improving reproductive health. Finally, the authors recommend a three-pronged approach to reducing maternal mortality among the Rohingya in Bangladeshi refugee camps. We suggest using Maternity Waiting Homes, Mama Rickshaws, and Traditional Birth Attendants to improve maternal health. These solutions address the three-delays model and place ownership into the community. Ultimately, the authors address a much-needed gap in the literature addressing Rohingya maternal mortality. [ABSTRACT FROM AUTHOR]

Professional social networking websites are commonly used among young professionals. In light of emerging concerns regarding social networking use and emotional distress, the purpose of this study was to investigate the association between frequency of use of LinkedIn, the most commonly used professional social networking website, and depression and anxiety among young adults. In October 2014, we assessed a nationally representative sample of 1,780 U.S. young adults between the ages of 19-32 regarding frequency of LinkedIn use, depression and anxiety, and sociodemographic covariates. We measured depression and anxiety using validated Patient-Reported Outcomes Measurement Information System measures. We used bivariable and multivariable logistic regression to assess the association between LinkedIn use and depression and anxiety, while controlling for age, sex, race, relationship status, living situation, household income, education level, and overall social media use. In weighted analyses, 72% of participants did not report use of LinkedIn, 16% reported at least some use, but less than once each week, and 12% reported use at least once per week. In multivariable analyses controlling for all covariates, compared with those who did not use LinkedIn, participants using LinkedIn at least once per week had significantly greater odds of increased depression (adjusted odds ratio [AOR] = 2.10, 95% confidence interval [CI] = 1.31-3.38) and increased anxiety (AOR = 2.79, 95% CI = 1.72-4.53). LinkedIn use was significantly related to both outcomes in a dose-response manner. Future research should investigate directionality of this association and possible reasons for it. [ABSTRACT FROM AUTHOR]

Over one-third of women experience intimate partner violence (IPV) in their lifetime. IPV increases the risk of infection and re-infection with sexually transmitted infections (STIs). The extent to which health care providers consider IPV when recommending partner notification and expedited partner therapy is unknown. The objective of this qualitative study was to understand health care providers' views on IPV and STIs when recommending partner treatment to patients with chlamydia. Using a purposive sampling strategy to include health care providers who treat young women at risk for chlamydia, 23 semi-structured, in-depth interviews were conducted. While some health care providers expressed concern for their patients' safety and believed assessing for IPV was needed before provision of expedited partner therapy, nearly a third had not considered the links between IPV and STIs. Strategies used by health care providers to assess for IPV did not include inquiry about specific behaviours related to IPV, STI risk, and sexual coercion. Many health care providers understand the risk for IPV in the setting of STI treatment, yet a significant portion of those interviewed failed to recognise the link between IPV and STIs. Provider education is necessary to increase knowledge and implement more effective inquiry and counselling about IPV to more safely recommend expedited partner therapy. [ABSTRACT FROM AUTHOR]

Although Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an effective early intervention when used across healthcare settings, its implementation has been difficult, in part because of lack of training, healthcare providers' feelings of low self-efficacy in performing SBIRT, and negative attitudes about people who use alcohol and drugs. This study used qualitative descriptive methods to examine baccalaureate nursing students' experiences with practicing SBIRT in clinical rotations following in-depth classroom work and skill-based training. Fifty-five junior level nursing students participated in four focus groups. Three overarching themes describe students' experiences with S B IRT. Students expressed a positive impact of the training on their attitudes and feelings of self-efficacy regarding the use of SBIRT, differences in opinions about whether SBI RT should be used universally with all patients or as a targeted intervention with only some patients, and that SBIRT is a nursing responsibility. These results suggest that education and training can affect attitudes and efficacy, but that attention needs to be paid to how SBIRT is implemented within different healthcare settings. [ABSTRACT FROM AUTHOR]

In 1999, the Agency for Healthcare Research and Quality funded a study of barriers to immunization, which included a short-term qualitative data collection to assess the organizational and cultural features of selected primary care practices and to explore their impact on adult immunization rates. The authors describe the short-term qualitative data collection system and the contributions made by the qualitative study to the parent project. They address previously held concerns about qualitative research and provide a system that can be replicated or modified for use for projects designed to assess complex attitudes and behaviors that affect health outcomes. [ABSTRACT FROM AUTHOR]

This article examines the role of technical assistance (TA) in supporting the replication of proven HIV interventions. Effective interventions have now been identified across a spectrum of risky behaviors, including unsafe sex, violence, and alcohol and other substance use. The provision of TA helps new users overcome obstacles and encourages ownership and integration of the innovation into practice. The HIV prevention community is increasingly recognizing the role of TA in disseminating knowledge and best practices to communities to improve services at the local level. As an increasing number of effective HIV prevention interventions have been identified, an important component of TA has been the dissemination of information on the types of interventions that work best and under what circumstances. Before getting started, agencies needed guidance to understand how, where, and for whom the intervention would be implemented and to mobilize the support needed for smooth and continued delivery. Although TA requirements may differ according to the characteristics of the intervention, the types of TA provided across the REP interventions were strikingly similar.

The article focuses on the transfer of research-based HIV prevention interventions to community service providers. HIV prevention researchers and service providers can collaborate to develop interventions that not only are effective but can also be successfully implemented by service organizations. Behavioral research methods generally require that an intervention being tested in a controlled study be delivered consistently and in close fidelity to the protocol. In keeping with the emphasis on showing program effectiveness, community-based organizations (CBOs), AIDS service organizations, and other service providers are usually expected by their funding agencies to conduct HIV prevention interventions known to reduce HIV risk behavior, HIV incidence, or both. CBOs that undertake HIV prevention programs usually have a long history of providing services in their communities and a grassroots understanding of the populations they serve. The elements of an intervention can be defined as core, or critical, by virtue of behavioral science theory, experience in implementing the intervention, or a formal component analysis of its procedures. The objective of evaluating the effectiveness of HIV prevention approaches is to inform the development of interventions for the field.

This article describes the orientation and training used in one of the Replicating Effective Programs (REP) projects supported by the U.S. Centers for Disease Control and Prevention (CDC) and identifies some critical issues to be considered based on lessons learned. The Real AIDS Prevention Project (RAPP) is a multicomponent, community-based HIV prevention intervention based on research originally funded by CDC as part of the HIV Prevention in Women and Infants Demonstration Projects. RAPP, the model developed by Family Health Council, Inc. in Pittsburgh, Pennsylvania was selected for inclusion in the REP project as an example of this multisite intervention. A community-based social service agency in a small city near Pittsburgh then conducted a trial run of the full intervention package. In addition to the outreach specialist, the RAPP staff consisted of peer network volunteers. Although each of the REP projects had different interventions, audiences, and training, a comparison of experiences identified a number of common issues. As research is translated to practice, orientation and training must build on the materials in the intervention package and serve as a basis for the identification and provision of technical assistance.

The article reports that the replicating Effective Programs (REP) project of the U.S. Centers for Disease Control supported researchers in developing intervention packages designed to help prevention partners replicate effective programs in their settings. The Mpowerment Project, a community-based HIV prevention program for young gay and bisexual men, has been shown to be effective in reducing rates of unprotected anal sex in its target population. The REP project supports original researchers in developing packages of materials to guide others in implementing interventions with demonstrated evidence of effectiveness. The Mpowerment Project is a community-level HIV prevention program for young gay and bisexual men that are based on theories about community and personal empowerment, community organizing and diffusion of innovation. Methods for facilitating empowerment and developing a cohesive and supportive community are not easily specified through a simple list of steps. Development of the Mpowerment Project's program manual progressed in a series of stages, each of which incorporated input from different sources. The intervention package facilitates the movement from identification of effective HIV prevention interventions through research to effective implementation of the interventions by those on the front lines of HIV prevention work.

The article presents information on the Women and Infants Demonstration Project (WIDP), a behavioral intervention research effort funded by the U.S. Centers for Disease Control (CDC). The major goal of the WIDP is to design, implement, and evaluate a community-level HIV prevention intervention effort that promotes behavioral change in a broad cross section of reproductive-aged women. The WIDP was developed as a refinement and expansion of the AIDS Community Demonstration Projects, an earlier research effort sponsored by the CDC focusing on decreasing behaviors that put people at risk for HIV infection. The WIDP intervention protocols are based on behavioral and social science theory and practice. Social learning theory is the second theoretical base for the WIDP. Initial project activities in each WIDP site included formative research efforts, which involved extensive interviewing of community leaders and residents. A critical component of the WIDP intervention is the production and distribution of community-tailored HIV/STD and pregnancy prevention role-model stories, which are cultural and gender specific.

The article provides insight into how to achieve a strategic approach to work/life by examining the current state of work/life programming in U.S. business. It explores several case studies that illustrate the strategic value of these activities and outlines a process for focusing on work/life as a management philosophy and not simply a series of programs and benefits. It is suggested that a strategic approach should link competitive positioning identified via benchmarking directly back to the organization's unique business and human resources goals. When employers achieve this, they will have adopted a work/life approach to management that in turn results in a workforce that is more creative and flexible.

Gestational diabetes mellitus (GDM) is the most common complication of pregnancy and contributes to increased risk for T2D in both the mother and offspring. American Indians are at higher risk of GDM and subsequent diagnosis of T2D than non-Hispanic white women. This project examined the experiences of American Indian mother-daughter (M-D) dyads as participants and the site coordinators who facilitated a GDM risk reduction and preconception counseling randomized controlled trial (RCT) to evaluate Stopping GDM (SGDM). The SGDM RCT included 4 visits over 9 months which dyads attended together but completed SGDM intervention (video and eBook) and questionnaires separately. SGDM content included GDM risk reduction (e.g., healthy nutrition), GDM risk awareness/health beliefs, preconception counseling, reproductive health communication, and family planning. For this study, dyads (n=22 dyads) were recruited from three of the five study sites and site coordinators from all sites participated (n=6). Mothers, daughters, and site coordinators were in separate focus groups. Focus groups were facilitated by trained qualitative researchers, conducted/recorded remotely using Zoom, transcribed verbatim, and analyzed using qualitative content analysis and Atlas.ti. Themes include: 1) SGDM provided valuable quality time and conversation about GDM and reproductive health among dyads; 2) GDM risk factors and risk reduction was largely new information for most dyads; 3) all sites experienced challenges to study engagement and recruitment; 4) recommendations for study improvement: personalized recruitment that is clinic-based and mother-focused; remote/asynchronous study visits; and significantly shorter content. These findings will be used to inform revisions of SGDM to improve the program and for a broader, more inclusive version of the program for other at-risk females. Disclosure: S. A. Stotz: None. A. F. Fischl: None. M. A. Terry: None. H. Garrow: None. N. O'banion: None. L. Chalmers: None. K. R. Moore: None. D. Charron-prochownik: None. Funding: National Institutes of Health (UL1TR001857 to D.C-P.); National Institute of Nursing Research (1R01NR014831-01A1 to D.C-P., K.R.M.) [ABSTRACT FROM AUTHOR]

While there is research on survivors of domestic violence in India and the United States (U.S.), little is known about the sociocultural factors related to domestic violence among Hindu Asian Indian immigrant women (AIIW) in the U.S. The objectives of this study were to a) test the feasibility of conducting domestic violence research among Hindu AIIW; b) investigate domestic violence prevalence and correlations with other characteristics; and c) test the cultural appropriateness of completed measures on social support, acculturation status, and domestic violence. Over 50% of respondents had experienced abuse, often perpetrated by family. Participants had high levels of social support and acculturation, regardless of their abuse status. Participants were receptive to this research, suggesting that domestic violence research among Hindu AIIW is feasible. High prevalence of violence among Hindu AIIW suggests they are at high risk for experiencing abuse; lack of variability in social support and acculturation scale responses suggest the need to further test instruments among Hindu AIIW. [ABSTRACT FROM AUTHOR]

Rural Pennsylvania has one of the highest rates of diabetes and recently, researchers at the University of Pittsburgh Diabetes Institute and Graduate School of Public Health have turned their attention to this issue. One possible initiative suggested implementing a top-down computer-based system. Though this approach allows for clinic-based tracking of care and adherence to ADA standards of care, it does not extend support for day-to-day management of diabetes into the community. In order to gauge needs and barriers around diabetes self-management, focus groups were conducted in four rural Pennsylvania communities. Focus groups, which take advantage of social learning and group process, are effective for exploring in-depth knowledge, attitudes, beliefs and opinions about a particular topic, especially when little is known about them. The methodology involves a guided discussion led by a trained facilitator. Based on components of the chronic care model, questions asked about local resources, barriers to self-management, meeting standards of care, features of health care systems and delivery and use of computer-based management system for medical information. Participants were recruited purposively and represented diabetes health educators, physicians, nutritionists, hospital administrators and clients. Although there were differences across the communities, a number of commonalities emerged. Among the results are these: resources include diabetes health education programs and support groups, health fairs and knowledgeable individuals. Barriers to management include poverty, lack of affordable exercise programs and insurance restrictions. Continued education is critical for improving adherence to standards of care; also important is the presence of a full-time endocrinologist. Accessing diabetes care through the health system is complicated and could be made easier by use of "navigators." While providers admitted that access to computer-based records facilitates clinic-based care, computer-based management is not necessarily a practical choice for people with diabetes, nor does it automatically result in effective self-management. [ABSTRACT FROM AUTHOR]