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Depression can disproportionately affect low-income women. The purpose of this study was to explore the chronicity of depressive symptoms in a sample of 276 low-income inner-city mothers of children with high-risk asthma. The aims were to identify factors (asthma health status, stress, social support) associated with change in depressive symptomatology over 12 months as well as to ascertain what factors are most consistently associated with depressive symptoms. Using latent growth curve analysis, demographic variables, asthma severity, stress, and social support failed to explain changes in depressive symptomatology. The growth curve models, however, were predictive of Center for Epidemiologic Studies–Depression Scale (CES-D) scores at distinct time points indicating that higher daily stress and lower social support were associated with increased depressive symptoms. Our data highlight the chronic nature of depressive symptoms in low-income mothers of children with poorly controlled asthma. Integrating questions about caregiver psychological state across all clinical encounters with the family may be indicated. [ABSTRACT FROM AUTHOR]

Bullying among children and adolescents is recognized as a significant global public health problem, as it has serious health consequences. Schools are important sites in which to address violence prevention, specifically bullying prevention, and to promote positive youth development. The Ottawa Charter for Health Promotion outlines five action points (building healthy public policy, creating supportive environments, strengthening community actions, developing personal skills, and reorienting health services) that should be considered when creating a positive school climate focused on health promotion. Using the position statements of school nurses and school psychologists, we outline their complementary roles in bullying prevention and intervention. In addition, because the global and national school health models call for building partnerships and enhancing communication among professionals within the schools and with the community to achieve health goals, we discuss how these two professional groups can work collaboratively to address bullying as a school health issue. [ABSTRACT FROM AUTHOR]

Background. Effective pediatric guideline-based asthma care requires the caregiver to accurately relay the child's symptom frequency, pattern of rescue and controller medication use, and level of asthma control to the child's primary care clinician. Objective. This study evaluated the longitudinal effects of a caregiver-clinician asthma communication education intervention (ACE) relative to an asthma education control group (CON) on symptom days and controller medication use in inner-city children with asthma. Participants and Methods. 231 inner-city children with asthma, recruited from urban pediatric emergency departments (EDs) and community practices, were followed for 12 months. Data included number of symptom days and nights, ED visits, hospitalizations, presence of limited activity, and controller medication use over 12 months. Pharmacy records were used to calculate controller to total asthma medication ratios as a proxy of appropriate controller medication use. Multivariate logistic regression models were used to identify factors associated with number of symptom days and nights over the past 30 days at the 12-month follow-up. Results. Most caregivers rated the communication with their child's clinician as high. Unadjusted and adjusted rates of symptom days and nights did not differ by group at follow-up. ACE children trended towards a higher controller to total medication ratio at 12 months as compared to CON children (mean ratio: ACE: 0.54, SD 0.3; CON, 0.45, SD 0.4; p = .07). Activity limitation due to asthma and persistent asthma severity were the only factors significantly associated with reporting any symptom day within the past 30 days, adjusting for treatment group, number of oral corticosteroid courses and number of clinician visits in the last 6 months, seasonality, insurance type, and controller to total asthma medication ratio covariates. Conclusion. A home-based caregiver asthma communication educational intervention was not associated with decreased symptom days. However, a trend was noted in higher controller to total medication ratios in the intervention group. Inner-city caregivers of children with asthma may require a health systems approach to help convey the child's asthma health information to their clinician. [ABSTRACT FROM AUTHOR]

This secondary data analysis study examines the relationship between maternal sociodemographic variables, life events, chronic stressors, including asthma control and management and environmental stressors, and maternal depression. Design: Cross-sectional descriptive design study consisting of baseline data from participants enrolled in a randomized asthma communication educational intervention trial. Sample: 201 mothers of children with asthma (ages 6–12), recruited from community pediatric practices and emergency departments of 2 urban university hospitals. Measurement: Life events were measured using standardized items. Chronic stressors were measured using items from the International Asthma and Allergies in Childhood study and maternal and child exposure to violence. Depressive symptoms were assessed with the Center for Epidemiologic Studies-Depression scale. Results: Close to 25% of the mothers had high depressive symptoms. In separate multiple logistic regression models, education (adjusted odds ratio [AOR]=2.62; 95% confidence interval [CI]=1.07, 6.39) or unemployment (AOR=2.38; 95% CI=1.16, 4.90) and the use of quick relief medications (AOR=2.74; 95% CI=1.33, 5.66) for asthma were positively associated with depressive symptoms. Conclusions: Implications include the need to assess maternal depressive symptoms of mothers of children with asthma, in order to improve asthma management for low-income urban children. [ABSTRACT FROM AUTHOR]

Health promotion and disease prevention have always been essential to public health nursing. With the changing health care system and an increased emphasis on cost-containment, the role of the nurse is expanding even more into this arena. A challenge for public health nurses, then, is to motivate and facilitate health behavior change in working with individuals, families, and communities and designing programs based on theory. Leading causes of death continue to relate to health behaviors that require change. The purpose of this article is to integrate theory with practice by describing the Transtheoretical Model of Change as well as the principles of motivational interviewing that can be used in motivating behavioral change. A case scenario is presented to illustrate the use of the models with effective interviewing skills that can be used to enhance health. Implications for practice with an emphasis on providing an individually tailored matched intervention is stressed. [ABSTRACT FROM AUTHOR]

Focuses on the importance of patient-health care provider interaction and the influence of ethnicity to this interaction. Differences in medical belief systems; Influence of beliefs to health practices within popular, folk and professional areas of health care; Impact of complementary expectations between patients and providers; Influence of norms of behavior to the interaction.

Part Three of this series on public health nursing (PHN) history chronicles evolving definitions from 1950 to 2015 and reflects the changing landscape of practice. In the mid-20th century, PHN shifted toward "community health" by emphasizing connection with individuals and families in the community; collaboration with agencies and professionals; and focus on health teaching. Since 1950 there were many shifts, and we begin by discussing nursing practice in the community from 1950 to 1975. We follow this by considering practice and synthesis of nursing in public health from 1975 to 2000, and then concepts such as health promotion, disease prevention, population health and PHN workforce from 2000 to 2015. Growing interest in public health, in the throes of uncertain healthcare reforms, provides an imperative for reclaiming public health roles to promote and protect the health of populations; to join with public and private partners; to utilize public health competencies and science; and to co-create a base of influence and power for social change and progress. [ABSTRACT FROM AUTHOR]

Ruth Hubbard, a public health nursing (PHN) leader in 1950, offered a timeless comment, "To each age comes its own peculiar problems and challenges, but to it also comes the necessary vision and strength" (p. 608). Similar to the 1950s, from 1950 to 2015 unique healthcare and workforce issues continued to arise calling for public health nurses to respond with vision and strength. In Part Two of a three-part series on PHN history, we examine seminal documents, events, and policies that influenced practice. We begin by considering the time period 1950 to 1975, and then discuss healthcare transitions; social activism and community health planning; and concerns from the years 1975 to 2000 and 2000 to 2015. These milestones reflected challenges of emerging chronic diseases, re-emerging infectious diseases, immigration and terrorism, as well as post-war prosperity and improvements in health care. As in the early 20th century, response to challenges included periods of expansion and recession. We conclude by considering the past as prologue, discussing prospects for present and future PHN. [ABSTRACT FROM AUTHOR]

Reservation-based Native American youth are at disproportionate risk for high-risk substance use. The culture-as-treatment hypothesis suggests aspects of tribal culture can support prevention and healing in this context; however, the protective role of communal mastery and tribal identity have yet to be fully explored. The objectives of this study were to investigate (1) the relationship between cultural factors and high-risk substance use, which includes polysubstance use, early initiation of alcohol and illicit drugs, and binge drinking, and (2) substance use frequency and prevalence of various substances via cross-sectional design. Multiple logistic regression modeling was used to analyze data from 288 tribal members (15–24 years of age) residing on/near the Fort Peck Reservation in the Northern Plains. When controlling for childhood trauma and school attendance, having at least a high school education (OR = 0.434, p = 0.028), increased communal mastery (OR = 0.931, p = 0.007), and higher levels of tribal identity (OR = 0.579, p = 0.009) were significantly associated with lower odds of polysubstance use. Overall prevalence of polysubstance use was 50%, and binge drinking had the highest single substance prevalence (66%). Prevalence of early initiation of substances (≤ 14 years) was inhalants (70%), alcohol (61%), marijuana (74%), methamphetamine (23%), and prescription drug misuse (23%). Hydrocodone, an opioid, was the most frequently misused prescription drug. Findings indicate programs focused on promoting education engagement, communal mastery, and tribal identity may mitigate substance use for Native American adolescents living in high-risk, reservation-based settings. [ABSTRACT FROM AUTHOR]

A person's ability to minimize HIV risk is embedded in a complex, multidimensional context. In this study, we tested a model of how relationship power impacts IPV victimization, which in turn impacts HIV risk behaviors. We analyzed data from 474 young adult women (aged 15–31) in Cebu Province, Philippines, using structural equation modeling, and demonstrated good fit for the models. High relationship power is directly associated with increased IPV victimization, and IPV victimization is positively associated with increased HIV risk. We highlight in this article the complex dynamics to consider in HIV risk prevention among these young women. [ABSTRACT FROM PUBLISHER]

The article presents a study which examines the prevalence and risk factors of workplace violence (WPV) among 2166 hospital nurses in the U.S. Multivariate logistic regression was utilized using data from an online cross-sectional survey to determine risk factors for physical and psychological WPV. Findings of the study showed that almost one-third of nurses have experienced WPV and that WPV risk factors included being a male nurse, older age, and childhood abuse.

Low income, urban children with asthma are experiencing community violence that may contribute to asthma morbidity. The objective of this study was to examine the relationship between caregiver report of feeling unsafe, seeing community violence or child seeing community violence and asthma morbidity and health care utilization. Two hundred thirty-one caregivers of children with asthma enrolled in an asthma,education, intervention reported perceptions of safety and violence exposure in six months and frequency of child asthma symptoms, emergency department (ED), primary care (PCP) visits and hospitalizations over 12 months. Children were primarily male (93%), black (61%), and reported income <$30,000 (56%). Violence exposure was high: feeling unsafe (25%), seeing violence themselves (22%), child saw violence (14%). If caregivers or children saw violence, there were significantly more nighttime symptoms than those who were not exposed (caregiver: yes violence = 6.72 ± 9.19, no violence = 4.23 ± 6.98, P = 0.03; child: yes violence = 7.09 ± 7.15, no violence = 4.37 ± 9.49, P = 0.05). Children who saw violence were less likely to see their PCP. Families exposed to community violence report more asthma symptoms, but are less likely to seek care for asthma. Health care providers and asthma educators should evaluate potential violence exposure with asthma patients and tailor care and education to include violence prevention and avoidance. [ABSTRACT FROM AUTHOR]

This article critically reviews 62 empirical studies that examine the prevalence of female-perpetrated intimate partner violence across three distinct populations (adolescents, college students, and adults). All studies were published between 1996 and 2006 and reported prevalence rates of physical, emotional, and/or sexual violence perpetrated by females in heterosexual intimate relationships. The highest rates were found for emotional violence, followed by physical and sexual violence. Prevalence rates varied widely within each population, most likely because of methodological and sampling differences across studies. Few longitudinal studies existed, limiting the extent to which we could identify developmental patterns associated with female-perpetrated intimate partner violence. Differences and similarities across populations are highlighted. Methodological difficulties of this area of inquiry as well as implications for practice, policy, and research are discussed. [ABSTRACT FROM AUTHOR]

Presents a contextual and longitudinal analysis of women's responses to battering over time. Assessment of women's decision-making in terms of the relationship status and continuing or cessation of abuse; Relationship status over time; Process of achieving nonviolence.

Asthma morbidity and mortality are disproportionately higher among African American children. Medication adherence is essential for reducing adverse asthma outcomes in this population. Depressive symptoms, prevalent among mothers of children with asthma, have been linked to medication nonadherence. This longitudinal, multilevel analysis used data from a randomized clinical trial evaluating the efficacy of an environmental control educational intervention to evaluate the relationship between caregiver depressive symptoms (Center for Epidemiologic Studies Depression Scale) and caregiver-reported medication adherence (Medication Adherence Report Scale) in urban African American children with uncontrolled asthma (N = 208) at baseline, in six months, and in 12 months. Nearly a third (31.7%) of caregivers (97% female) had clinically significant depressive symptoms at baseline. A random intercept model showed that the within-caregiver effect of depression predicted lower medication adherence (β = –.079, p =.002) as did time (β = –.413, p <.001); the between-caregiver effect of depression did not (β = –.007, p =.77). Changes in a caregiver's baseline level of depressive symptoms appear to have a stronger influence on medication adherence than mean level of depressive symptoms. Policy, practice, and further research should address maternal mental health as a key element in the life course of African American children with asthma. [ABSTRACT FROM AUTHOR]

Objective: Urban children with asthma experience high rates of second hand smoke (SHS) exposure. The objective was to examine whether SHS exposure is associated with symptom frequency in children with poorly controlled asthma. Methods: Children were enrolled in a RCT to test the efficacy of an environmental control behavioral intervention versus an attention control group and followed over 12 months. SHS exposure assessed using salivary cotinine measurement. Frequency of child asthma symptoms, healthcare utilization, household smoking and caregiver daily life stress were obtained via caregiver report. Time of enrollment was recorded to assess seasonal factors. Symptom days and nights were the primary outcomes. Multivariable models and odds ratios examined factors that best predicted increased frequency of daytime/nighttime symptoms. Results: Children (n = 222) with a mean age of 6.3 (SD 2.7) years, were primarily male (65%), African American (94%), Medicaid insured (94%), and had poorly controlled asthma (54%). The final multivariable model indicated symptoms in the fall (OR 2.78; 95% CI 1.16, 6.52) and increased caregiver daily life stress (OR 1.13, 95% CI 1.02, 1.25) were significantly associated with increased symptom days when controlling for cotinine level, intervention status, child age and home and car smoking restrictions. Conclusions: There was no impact of SHS exposure on increased symptom frequency. High caregiver daily life stress and symptoms in fall season may place children with asthma at risk for increased day/nighttime symptoms. Close monitoring of symptoms and medication use during the fall season and intervening on caregiver life stress may decrease asthma morbidity in children with poorly controlled asthma. [ABSTRACT FROM AUTHOR]

The goal of this longitudinal analysis was to characterize factors associated with the experience of life stress in low-income, inner-city mothers of minority children with high-risk asthma.Participants (n = 276) reported on family demographics, child asthma control and healthcare utilization, social support, contemporary life difficulties (housing, finances, violence exposure) measured by the validated Crisis in Family Systems scale, and daily stress. Latent growth curve modeling examined predictors of life stress across 12 months as a function of home and community difficulties, asthma-specific factors, and social support. Mothers were primarily single (73%), unemployed (55%), and living in extreme poverty with most (73%) reporting an annual family income <$20,000 (73%). The children were young (mean age = 5.59, SD = 2.17), African-American (96%), and had poorly controlled asthma (94%) at study enrollment. Higher daily stress was associated with financial difficulties, safety concerns in the home and community, and housing problems. Access to social support was consistently related to reduced stress. The only asthma-specific factor associated with life stress was healthcare utilization, with more emergency services for asthma related to higher daily stress. Findings underscore the clinical significance of assessing diverse home and community stressors and social support in low-income, inner-city caregivers of children with poorly controlled asthma. [ABSTRACT FROM AUTHOR]

Context: Patients with terminal illnesses often require surrogate decision makers. Prior research has demonstrated high surrogate stress, and that despite standards promoting substituted judgment, most patients do not want their surrogates to make pure substituted judgments for them. It is not known how best to help loved ones fulfill the surrogate role.Objectives: To test the effectiveness of an intervention to help surrogate decision makers.Methods: One hundred sixty-six patients (41% with amyotrophic lateral sclerosis and 59% with gastrointestinal cancers) and their surrogates at two university medical centers were randomized to an intensive nurse-directed discussion of the end-of-life decision control preferences of the patient (TAILORED) or a discussion of nutrition (CONTROL); 163 completed baseline interviews and underwent the intervention.Results: Twelve patients died during follow-up and 137 dyads completed the study. Post-intervention, using all available data, TAILORED patients and surrogates became more likely to endorse mutual surrogate decision making, that is, a balance of their own wishes and what the surrogate thinks best (adjusted odds compared with baseline for patients = 1.78, P = 0.04; adjusted odds for surrogates = 2.05, P = 0.03). CONTROL patients became 40% less likely to endorse mutual surrogate decision making (P = 0.08), and CONTROL surrogates did not change significantly from baseline (adjusted odds = 1.44, P = 0.28). Stress levels decreased for TAILORED surrogates (impact of events scale = 23.1 ± 14.6 baseline, 20.8 ± 15.3 f/u, P = 0.046), but not for CONTROL (P = 0.85), and post-intervention stress was lower for TAILORED than CONTROL (P = 0.04). Surrogates' confidence was uniformly high at baseline and did not change. Caregiver burden (Zarit) increased from 12.5 ± 6.5 to 14.7 ± 8.1 for TAILORED (P < 0.01), while not changing for CONTROL, yet satisfaction with involvement in decision making was higher at follow-up for TAILORED than for CONTROL (71% vs. 52%, P = 0.03).Conclusion: TAILORED patients and surrogates who completed the study adopted a more mutual decision-making style, balancing their own wishes with what the surrogate thinks would be best for them. Surrogates reported less stress and more satisfaction. Confidence was high at baseline and did not change. There was a modest increase in caregiver burden. These findings suggest that interventions like TAILORED might positively impact surrogate decision making. [ABSTRACT FROM AUTHOR]

Objective: Low-income caregivers of young children with high-risk asthma experience social stressors and illness-related demands that may impede effective home asthma management. Knowledge of the caregiving experience in the context of poverty is limited.Methods: Convenience sampling methods were used to recruit low-income caregivers of children aged 7–12 years, who are frequently in the Emergency Room (ED) for uncontrolled asthma. Thirteen caregivers participated in focus groups that were designed to elicit reflections on asthma home and community management from the caregiver perspective. A grounded theory approach was used in the open coding of transcript data from three focus groups, as well as to revise and reorganize emerging themes and sub-themes. Results: Participants (Mean age = 33.9 years) were predominantly the biological mother (92.3%), single (84.6%), and impoverished (69.2% reported annual household income ≤ $30,000). Their children (Mean age = 7.8 years) were African-American (100%), enrolled in Medicaid (92.3%), averaged 1.38 (SD = 0.7) ED visits over the prior 3 months, resided in homes with at least one smoker (61.5%), and nearly all (84.6%) experienced activity limitations due to asthma. Five themes emerged in the analysis: intensive caregiving role, complex and shared asthma management responsibility, parental beliefs and structural barriers to guideline-based care, lack of control over environmental triggers, and parent advocacy to improve child asthma care and outcomes.Conclusions: Caregivers managing a child with high-risk asthma in the context of poverty indicate the need for ongoing asthma education, increased sensitivity to the complexity of home asthma management, and family-centered interventions that enhance communication and collaboration between caregivers and providers. [ABSTRACT FROM AUTHOR]

Aims and Objectives The purpose of this study was to consider how fear and symptom experience are perceived in patients with heart failure at the end of life. Background Heart failure is a burdensome condition and mortality rates are high globally. There is substantive literature describing suffering and unmet needs but description of the experience of fear and the relationship with symptom burden is limited. Design A convergent mixed methods design was used. Methods Data from the McGill Quality of Life Questionnaire ( n = 55) were compared to data from in-depth interviews ( n = 5). Results Patients denied fear when asked directly, but frequently referred to moments of being afraid when they were experiencing symptoms. In addition, patients reported few troublesome symptoms on the survey, but mentioned many more symptoms during interviews. Conclusions These data not only identify the relationship between psychological issues and symptom experience but also elucidate the benefit of a mixed method approach in describing such experiences from the perspective of the patient. Future research should examine relationships between and among symptom experience, fear and other psychological constructs across the illness trajectory. Relevance to Clinical Practice Conversations about the interaction of symptom burden and fear can lead to both a more robust assessment of symptoms and lead to patient centred interventions. [ABSTRACT FROM AUTHOR]

Setting: Multidrug-resistant tuberculosis (MDR-TB) unit in KwaZulu-Natal, South Africa. Objective: To develop and evaluate a nurse case management model and intervention using the tenets of the Chronic Care Model to manage treatment for MDR-TB patients with a high prevalence of human immunodeficiency virus (HIV) co-infection. Design: A quasi-experimental pilot programme utilizing a nurse case manager to manage care for 40 hospitalized MDR-TB patients, 70% HIV co-infected, during the intensive phase of MDR-TB treatment. Patients were followed for six months to compare proximal outcomes identified in the model between the pre- and post-intervention period. Results: The greatest percent differences between baseline and six-month MDR-TB proximal outcomes were seen in the following three areas: baseline symptom evaluation on treatment initiation (95% improvement), baseline and monthly laboratory evaluations completed per guidelines (75% improvement), and adverse drug reactions acted upon by medical and/or nursing intervention (75% improvement). Conclusion: Improvements were identified in guideline-based treatment and monitoring of adverse drug reactions following implementation of the nurse case management intervention. Further study is required to determine if the intervention introduced in this model will ultimately result in improvements in final MDR-TB treatment outcomes. [ABSTRACT FROM AUTHOR]

We examined the longitudinal effects of community risk and protective factors on asthma morbidity and healthcare utilization. Three hundred urban caregivers of children with poorly controlled asthma were enrolled in a randomized controlled trial testing the effectiveness of a behavioral/educational intervention and completed measures of exposure to community violence (ECV), social cohesion (SC), informal social control (ISC), child asthma control, child asthma symptom days/nights, and healthcare utilization. Latent growth curve modeling examined the direct and interaction effects of ECV, SC, and ISC on the asthma outcomes over 12 months. Caregivers were primarily the biological mother (92 %), single (70 %), and poor (50 % earned less than $10,000). Children were African American (96 %) and young (mean age = 5.5 years, SD = 2.2). ECV at baseline was high, with 24.7 % of caregivers reporting more than two exposures to violence in the previous 6 months (M = 1.45, SD = 1.61). Caregiver ECV-predicted asthma-related healthcare utilization at baseline ( b = 0.19, SE = 0.07, p = 0.003) and 2 months ( b = 0.12, s.e. = 0.05, p = 0.04). ISC and SC moderated the effect of ECV on healthcare utilization. Our findings suggest that multifaceted interventions that include strategies to curb violence and foster feelings of cohesion among low-income urban residents may be needed to reduce asthma-related emergency services. [ABSTRACT FROM AUTHOR]

Objectives: Rates of preventive asthma care after an asthma emergency department (ED) visit are low among inner-city children. The objective of this study was to test the efficacy of a clinician and caregiver feedback intervention (INT) on improving preventive asthma care following an asthma ED visit compared to an attention control group (CON). Methods: Children with persistent asthma and recent asthma ED visits ( N = 300) were enrolled and randomized into a feedback intervention or an attention control group and followed for 12 months. All children received nurse visits. Data were obtained from interviews, child salivary cotinine levels and pharmacy records. Standard t-test, chi-square and multiple logistic regression tests were used to test for differences between the groups for reporting greater than or equal to two primary care provider (PCP) preventive care visits for asthma over 12 months. Results: Children were primarily male, young (3-5 years), African American and Medicaid insured. Mean ED visits over 12 months was high (2.29 visits). No difference by group was noted for attending two or more PCP visits/12 months or having an asthma action plan (AAP). Children having an AAP at baseline were almost twice as likely to attend two or more PCP visits over 12 months while controlling for asthma control, group status, child age and number of asthma ED visits. Conclusions: A clinician and caregiver feedback intervention was unsuccessful in increasing asthma preventive care compared to an attention control group. Further research is needed to develop interventions to effectively prevent morbidity in high risk inner-city children with frequent ED utilization. [ABSTRACT FROM AUTHOR]

We examine current perceptions and constraints surrounding condom use among young adults in the Philippines to garner a deeper contextual understanding of this aspect of HIV prevention within Filipino society. Through thematic analysis of focus group data, we found three broad themes, all of which include societal and individual barriers to using condoms. The findings may provide insight for similar settings in which religion has a strong influence on society. To strengthen HIV prevention efforts in such settings, we suggest that the development of strategies to address these constraints and promote healthy sexuality in young adults is essential. [ABSTRACT FROM AUTHOR]

Background. Rates of preventive follow-up asthma care after an acute emergency department (ED) visit are low among inner-city children. We implemented a novel behavioral asthma intervention, Pediatric Asthma Alert (PAAL) intervention, to improve outpatient follow-up and preventive care for urban children with a recent ED visit for asthma. Objective. The objective of this article is to describe the PAAL intervention and examine factors associated with intervention completers and noncompleters. Methods. Children with persistent asthma and recurrent ED visits ( N = 300) were enrolled in a randomized controlled trial of the PAAL intervention that included two home visits and a facilitated follow-up visit with the child's primary care provider (PCP). Children were categorized as intervention completers, that is, completed home and PCP visits compared with noncompleters, who completed at least one home visit but did not complete the PCP visit. Using chi-square test of independence, analysis of variance, and multiple logistic regression, the intervention completion status was examined by several sociodemographic, health, and caregiver psychological variables. Results. Children were African-American (95%), Medicaid insured (91%), and young (aged 3-5 years, 56%). Overall, 71% of children randomized to the intervention successfully completed all home and PCP visits (completers). Factors significantly associated with completing the intervention included younger age (age 3-5 years: completers, 65.4%; noncompleters, 34.1%; p < .001) and having an asthma action plan in the home at baseline (completers: 40%; noncompleters: 21%; p = .02). In a logistic regression model, younger child age, having an asthma action plan, and lower caregiver daily asthma stress were significantly associated with successful completion of the intervention. Conclusions. The majority of caregivers of high-risk children with asthma were successfully engaged in this home and PCP-based intervention. Caregivers of older children with asthma and those with high stress may need additional support for program completion. Further, the lack of an asthma action plan may be a marker of preexisting barriers to preventive care. [ABSTRACT FROM AUTHOR]

Purpose. The purpose of this study was to explore the experiences of nurse volunteers caring for children after the Haiti earthquake in January 2010. Design and Methods. This descriptive qualitative study using in-depth interviews focuses on the experiences of 10 nurse volunteers. Results. Four themes emerged: hope amid devastation, professional compromises, universality of children, and emotional impact on nurses. Practice Implications. Nurses who volunteer after natural disasters have rich personal and professional experiences, including extremes of sadness and joy. Nurse volunteers will likely need to care for children. Nurses and humanitarian agencies should prepare for the unique challenges of pediatric care. [ABSTRACT FROM AUTHOR]

Background: Surrogate accuracy in predicting patient treatment preferences (i.e., what patients want) has been studied extensively, but it is not known whether surrogates can predict how patients want loved ones to make end-of-life decisions on their behalf.Objective: To evaluate the ability of family members to correctly identify the preferences of seriously-ill patients regarding family involvement in decision making.Design: Cross-sectional survey.Participants: Twenty-five pancreatic cancer and 27 amyotrophic lateral sclerosis (ALS) patients and their family members (52 dyads total).Main Measures: Patients and family members completed the Decision Control Preferences (DCP) scale regarding patient preferences for family involvement in health care decisions using conscious and unconscious scenarios.Key Results: Patient and family member agreement was 56% (29/52 dyads) for the conscious scenario (kappa 0.29) and 46% (24/52 dyads) for the unconscious scenario (kappa 0.15). Twenty-four family members identified the patient's preference as independent in the unconscious scenario, but six of these patients actually preferred shared decision making and six preferred reliant decision making. In the conscious scenario, preference for independent decision making was associated with higher odds of patient-family agreement (AOR 5.28, 1.07-26.06). In the unconscious scenario, cancer patients had a higher odds of agreement than ALS patients (AOR 3.86; 95% CI 1.02-14.54).Conclusion: Family members were often unable to correctly identify patient preferences for family involvement in end-of-life decision making, especially when patients desired that decisions be made using the best-interest standard. Clinicians and family members should consider explicitly eliciting patient preferences for family involvement in decision making. Additional research is still needed to identify interventions to improve family member understanding of patient preferences regarding the decision-making process itself. [ABSTRACT FROM AUTHOR]

Objectives. To examine the association of social and environmental factors with levels of second-hand smoke (SHS) exposure, as measured by salivary cotinine, in young inner-city children with asthma. Methods. We used data drawn from a home-based behavioral intervention for young high-risk children with persistent asthma post-emergency department (ED) treatment ( N = 198). SHS exposure was measured by salivary cotinine and caregiver reports. Caregiver demographic and psychological functioning, household smoking behavior, and asthma morbidity were compared with child cotinine concentrations. Chi-square and ANOVA tests and multivariate regression models were used to determine the association of cotinine concentrations with household smoking behavior and asthma morbidity. Results. Over half (53%) of the children had cotinine levels compatible with SHS exposure and mean cotinine concentrations were high at 2.42 ng/ml (SD 3.2). The caregiver was the predominant smoker in the home (57%) and 63% reported a total home smoking ban. Preschool aged children and those with caregivers reporting depressive symptoms and high stress had higher cotinine concentrations than their counterparts. Among children living in a home with a total home smoking ban, younger children had significantly higher mean cotinine concentrations than older children (cotinine: 3-5 year olds, 2.24 ng/ml (SD 3.5); 6-10 year olds, 0.63 ng/ml (SD 1.0); p < .05). In multivariate models, the factors most strongly associated with high child cotinine concentrations were increased number of household smokers (β = 0.24) and younger child age (3-5 years) (&#946 = 0.23; p < .001, R2 = 0.35). Conclusion. Over half of the young inner-city children with asthma were exposed to SHS, and caregivers are the predominant household smokers. Younger children and children with depressed and stressed caregivers are at significant risk of smoke exposures, even when a household smoking ban is reported. Further advocacy for these high-risk children is needed to help caregivers quit and to mitigate smoke exposure. [ABSTRACT FROM AUTHOR]

This study examines the prevalence and risk factors for intimate partner violence (IPV) and intimate partner abuse (IPA) against female nurses and nursing personnel ( n = 1981). Data were collected through online surveys conducted at three hospitals and one geriatric care center in a Mid-Atlantic US metropolitan area. Lifetime physical or sexual IPV was reported by 25% of participants and 22.8% reported experiencing lifetime emotional abuse by an intimate partner. Logistic regression analyses identified independent variables statistically related to IPV and IPA, including increased age, having children, not being married, and experiences of childhood abuse. Implications for women in the workplace are discussed. [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine relational aggression and its relationship with adverse psychosocial and physical health symptoms among urban, African American youth. Design and Sample: Quantitative, cross-sectional survey design. The sample consisted of 185 predominantly African American (95.1%) seventh-grade students (mean age: 13.0; female: 58%) attending 4 urban middle schools. Measures: The Children's Social Behavior Scale and Social Experience Questionnaire were used to measure relational aggression and relational victimization. The Pediatric Symptom Checklist was used to assess psychosocial difficulties, including internalizing behaviors, externalizing behaviors, and attention problems. Physical health symptoms were measured with questions about colds/flu, headaches, and stomach aches. Results: 2-way multivariate analysis of variance revealed significant differences in externalizing behavior, with perpetrators reporting higher levels than nonperpetrators. Victims reported more internalizing behavior than nonvictims; however, this was only significant for males. For females, significant negative effects on health outcomes were found, resulting from the interaction of perpetration and victimization. Conclusions: Findings suggest that relational aggression is a common occurrence among urban, minority adolescents and may result in adverse health outcomes. These results provide several avenues for future research and implications for healthcare practice. Intervention strategies are needed to prevent relational aggression and continual or subsequent adverse health symptoms. [ABSTRACT FROM AUTHOR]

Violence disproportionately affects low- and middle-income countries. Deeper understanding is needed in areas where little research has occurred. The objectives of the study were to: (a) ascertain rate of homicide death; (b) describe the victims and circumstances surrounding their deaths in Dar es Salaam, Tanzania in 2005. This study was developed by adapting the WHO/CDC Injury Surveillance Guidelines (Holder et al., 2001). Data on 12 variables were collected on all homicide deaths. Descriptive statistics and hypothesis tests were done when appropriate. Age standardised, age-specific and cause-specific mortality rates are presented. The overall homicide rate was 12.57 (males and females respectively: 22.26 and 2.64). Homicide deaths were 93.4% male, mostly unemployed, with a mean age of 28.2 years. Most deaths occurred in urban areas. Mob violence was the cause of 57% of deaths. The risk of homicide death for males was greater than the world average, but for females it was less. Most homicides were committed by community members policing against thieves. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To determine the role terminally ill patients would opt to have their loved ones and physicians play in healthcare decisions should they lose decision-making capacity and how this changes over time. DESIGN: Serial interviews. SETTING: The study institutions were The Johns Hopkins Medical Institutions in Baltimore, Maryland, and St. Vincent's Hospital, in New York. PARTICIPANTS: One hundred forty-seven patients with cancer, amyotrophic lateral sclerosis, or heart failure, at baseline and 3 and 6 months. RESULTS: Patients' baseline decision control preferences varied widely, but most opted for shared decision-making, leaning slightly toward independence from their loved ones. This did not change significantly at 3 or 6 months. Fifty-seven percent opted for the same degree of decision control at 3 months as at baseline. In a generalized estimating equation model adjusted for time, more-independent decision-making was associated with college education ( P=.046) and being female ( P=.01), whereas more-reliant decision-making was associated with age ( P<.001). Patients leaned toward more reliance upon physicians to make best-interest determinations at diagnosis but opted for physicians to decide based upon their own independent wishes (substituted judgment) over time, especially if college educated. CONCLUSION: Terminally ill patients vary in how much they wish their own preferences to control decisions made on their behalf, but most would opt for shared decision-making with loved ones and physicians. Control preferences are stable over time with respect to loved ones, but as they live longer with their illnesses, patients prefer somewhat less reliance upon physicians. [ABSTRACT FROM AUTHOR]

Objectives: To compare costs associated with intimate partner violence (IPV) overall and for selected physical health problems in a nonpoor, privately insured sample. Methods: We compared 185 women aged 21–55 who were physically and/or sexually abused between 1989 and 1997 and enrolled in a multisite metropolitan health maintenance organization (HMO) to 198 never abused women enrolled in the same plan who had been matched using propensity score stratification. Costs associated with HMO visits, hospital stays, referrals, and emergency room (ER) visits, prescriptions, and radiology are based on the Medicare Resource-Based Relative Value System, expressed in 2005 dollars. Results: Average health care costs for women who reported physical, sexual, and/or emotional abuse exceeded those of never abused women by $1,700 over the 3-year study period. Women who reported abuse within 12 months of interview had higher average costs, as did women who reported physical abuse; however, sexual or emotional abuse and previous abuse also elevated costs. Costs associated with neurologic symptoms, injuries, mental health care, and unclassified symptoms account for most of these differences. Conclusions: IPV elevates health care costs, not only among women currently experiencing abuse, but also among women for whom the abuse has ceased. Efforts to control health care costs should focus on early detection and prevention of IPV. [Copyright &y& Elsevier]

The current emphasis on best practices for school-based health and mental health programs brings with it the demand for evaluation efforts in schools. This article describes the challenges of launching a successful school program and evaluation, with lessons learned from three projects that focus on intimate partner violence. The authors discuss issues related to constraints on the research design in schools, the recruitment of schools and participants within schools, program and evaluation implementation issues, the iterative implementation-evaluation cycle, and the dissemination of programs and study findings. The authors emphasize the need for flexibility and cultural awareness during all stages of the process. [ABSTRACT FROM AUTHOR]

Objectives: This study describes active duty military (ADM) women's beliefs and preferences concerning domestic violence (DV) policy in the military.Methods: Telephone interviews were completed with 474 ADM women from all services, 119 of whom had experienced DV during their military service.Results: A majority (57%) supported routine screening. Although 87% said the military's policy on mandatory reporting should remain the same, only 48% thought abuse should be reported to the commanding officer; abused women were significantly less likely than nonabused women to agree with this aspect of the policy. ADM women's beliefs were similar to those of women in a previously studied civilian sample, except that 73% of ADM compared to 43% of civilian women thought routine screening would increase women's risk of further abuse.Conclusions: ADM women recognized both advantages and disadvantages of current DV policies. More research is urgently needed about actual outcomes of screening and reporting policies. [ABSTRACT FROM AUTHOR]

Objectives: This study describes active duty military (ADM) women's beliefs and preferences concerning domestic violence (DV) policy in the military. Methods: Telephone interviews were completed with 474 ADM women from all services, 119 of whom had experienced DV during their military service. Results: A majority (57%) supported routine screening. Al. though 87% said the military's policy on mandatory reporting should remain the same, only 48% thought abuse should be reported to the commanding officer; abused women were significantly less likely than nonabused women to agree with this aspect of the policy. ADM women's beliefs were similar to those of women in a previously studied civilian sample, except that 73% of ADM compared to 43% of civilian women thought routine screening would increase women's risk of further abuse. Conclusions: ADM women recognized both advantages and disadvantages of current DV policies. More research is urgently needed about actual outcomes of screening and reporting policies. [ABSTRACT FROM AUTHOR]

Abstract: Current approaches to end-of-life decision making are widely considered inadequate. We explored these complexities by examining how patients with terminal diagnoses would choose to involve their physicians and loved ones in making medical decisions, assuming they were able and unable to participate. Cross-sectional interviews of 130 patients recently diagnosed with fatal conditions were conducted. Patients were recruited from two academic medical centers using a modification of the Decision Control Preferences Scale, ranging from independent decision making to decision making that relies upon others. Patients were asked how they would balance their own wishes relative to the input of physician and loved ones in making medical decisions, and to weigh the input of loved ones relative to physician. Most patients (52%), assuming they had the capacity, would opt to share decision making with their physicians, but 15% would defer to their physicians and 34% would make decisions independently. Similarly, 44% would share decision making with their loved ones, but fewer (6%) would defer to their loved ones. Thirty-nine percent would rely upon their physicians'' judgments about what would be best for them rather than their own wishes if they became unconscious, compared with 15% who would do so if they were conscious (P < 0.001). Nonetheless, patients were more likely to weigh their loved ones'' input more heavily than their physicians'' input if they were unconscious (33%) than if they were conscious (7%, P = 0.05). Race, religion, gender, diagnosis, and health status were largely unassociated with patients'' decision control preferences. Patients with terminal diagnoses report a wide diversity of decision control preferences, but most would opt to share decision making with their physicians and loved ones. If unable to decide for themselves, they shift toward greater reliance on physician input relative to their own wishes but would weigh loved ones'' input more heavily than physician input. Deciding for patients who cannot speak for themselves may be more complex than has previously been reflected in law, policy, or clinical ethics. [Copyright &y& Elsevier]

This article reports qualitative findings of seven focus groups that illuminate the phenomenon of dating and dating violence from the perspective of the young adolescent. This study was part of a larger intervention project, "An Arts-Based Initiative for the Prevention of Violence Against Women and Girls," a collaboration of the Centers for Disease Control and Prevention and Johns Hopkins University, School of Nursing. Concepts of interest included: dating norms, ecological factors, elements of healthy and unhealthy relationships, and prevention strategies. Four themes emerged: respect versus disrespect, influence of friends, cost and benefit of sexual activity and violence as an acceptable response. The implications of this data highlight the need for school personnel to increase their awareness and understanding of the challenges middle school youth face. Dating violence prevention programs should be designed accordingly. [ABSTRACT FROM AUTHOR]

In a sample of 616 active duty military women, 30% reported adult lifetime intimate partner violence (IPV), defined as physical and/or sexual assault. The prevalence of IPV during the time of military service was 21.6%. Lifetime prevalence of any abuse, including emotional abuse and/or stalking, was 44.3%. Risk factors for IPV (lifetime and while in the military)from multivariate logistic regression were separated or divorced marital status (odds ratio = 5.23, 6.17, respectively), being widowed (odds ratio = 3.57, 4.57), having one child (odds ratio = 2.12, 2.49) or three or more children (odds ratio = 2.72, 3.34), and being enlisted personnel rather than officers (odds ratio = 2.45, 2.77). These prevalence rates and risk factors were similar to a demographically comparable civilian sample from the same geographic area. Existing military policies and programs should be examined and enhanced to maintain military readiness as well as reduce military women's risk of harm. [ABSTRACT FROM AUTHOR]

Intimate partner violence has been demonstrated to be a significant public health problem among African American women. This study provided an opportunity to examine prevalence of intimate partner violence and health consequences among a group of primarily middle-class, employed African American women enrolled in a privately insured HMO (n = 109 abused and 97 never-abused women). Significantly more abused African American women were divorced or widowed and had incomes less than $50,000 a year. Abused women had more health problems (central nervous system, gynecological, STDs, gastrointestinal), more health problems per medical visits, and more emergency room visits (p < .05) compared to never-abused women. The health consequences of abuse and its association with health disparities are discussed. [ABSTRACT FROM AUTHOR]

Background: Domestic violence results in long-term and immediate health problems. This study compared selected physical health problems of abused and never abused women with similar access to health care. Methods: A case-control study of enrollees in a multisite metropolitan health maintenance organization sampled 2535 women enrollees aged 21 to 55 years who responded to an invitation to participate; 447 (18%) could not be contacted, 7 (0.3%) were ineligible, and 76 (3%) refused, yielding a sample of 2005. The Abuse Assessment Screen identified women physically and/or sexually abused between January 1, 1989, and December 31, 1997, resulting in 201 cases. The 240 controls were a random sample of never abused women. The general health perceptions subscale of the Medical Outcomes Study 36-Item Short-Form Health Survey measured general health. The Miller Abuse Physical Symptom and Injury Scale measured abuse-specific health problems. Results: Cases and controls differed in ethnicity, marital status, educational level, and income. Direct weights were used to standardize for comparisons. Significance was tested using logistic and negative binomial regressions. Abused women had more (P<.05) headaches, back pain, sexually transmitted diseases, vaginal bleeding, vaginal infections, pelvic pain, painful intercourse, urinary tract infections, appetite loss, abdominal pain, and digestive problems. Abused women also had more (P≤001) gynecological, chronic stress-related, central nervous system, and total health problems. Conclusions: Abused women have a 50% to 70% increase in gynecological, central nervous system, and stress-related problems, with women sexually and physically abused most likely to report problems. Routine universal screening and sensitive in-depth assessment of women presenting with frequent gynecological, chronic stress-related, or central nervous system complaints are needed to support disclosure of domestic violence. [ABSTRACT FROM AUTHOR]