Application of the Toxic Stress Schema: An Exemplar for School Nurses.

For many children of color, the cumulative impact of pre-existing stressors, disparities, and pandemic-related losses has contributed to a toxic level of stress. Toxic stress can disrupt healthy brain development making children vulnerable to physical and mental health problems. School nurses are the primary health professionals who interact with children daily during the academic year, which positions them to identify risk factors within the social determinants of health that contribute to the development of toxic stress. The Toxic Stress Schema (TSS) provides a framework for assessment and care planning related to social determinants of health and potential sources of stress and/or buffering support for the physical and mental well-being of children. A case study approach is used to demonstrate the application of the TSS to school nursing and provide the basis for conceptualizing a plan of care and identifying resources to support the child's physical and mental health.

A Schema of Toxic Stress Informed by Racism, Transgenerational Stress, and Disadvantage.

INTRODUCTION: The Toxic Stress Schema (TSS) is an ecological framework with a social justice lens for identifying and alleviating stress and strengthening social determinants of health for children and families of color impacted by the COVID-19 pandemic and the cumulative effects of racism and generational, systemic inequities. METHOD: Relevant literature is reviewed, and examples were provided to illustrate the differential impacts of the "stress superstorm" of 2020 had on children of color based on their family's position on the advantage-disadvantage continuum. RESULTS: The utility of the TSS framework as a model for advanced nursing practice is demonstrated, and recommendations are formulated for the pediatric nurse practitioner's role in health policy. DISCUSSION: The COVID-19 pandemic elucidated the historical inequities experienced by children and families of color. The TSS framework provides a model for recognizing, organizing, and implementing.

The evolution of a clinical scholars program through a pediatric nursing academic-practice partnership.

Academic-practice partnerships have the potential to improve clinical outcomes through joint initiatives focusing on nursing. Nurses at the bedside are able to greatly impact care, but often they lack the resources (time, knowledge, and expertise) to enact and facilitate quality improvement initiatives. Through an academic-practice partnership, academic and practice partners can work collaboratively to develop innovative evidence-based practice, quality improvement, and research projects. The benefits of these partnerships are far reaching as they involve faculty, students, and clinicians within the practice. In this article, we describe the development and evolution of a pediatric clinical scholars program that increases nursing engagement for leadership in evidence-based practice, quality improvement, and research projects to improve health outcomes.

Perceived Racial Discrimination in the Pregnant African American Population: A Concept Analysis.

African American women experience higher lifetime exposure to chronic stressors, such as perceived racial discrimination. Clearly defining perceived racial discrimination in the pregnant African American population has the potential to better explain the phenomenon and how it relates to adverse birth outcomes such as preterm birth. The purpose of this concept analysis is to more clearly define perceived racial discrimination in the pregnant African American population using Rodgers' evolutionary method. Defining the concept of interest has the potential to uncover modifiers that may help close the gap in the Black-White infant mortality rates in the United States.

Sexual behaviors and human papillomavirus vaccine non-initiation among young adult cancer survivors.

BACKGROUND: Young adult cancer survivors are at risk for subsequent human papillomavirus (HPV)-related malignancies. High-risk sexual behavior increases risk for HPV acquisition; HPV vaccination protects against infection. We aimed to determine the prevalence of sexual behaviors, factors related to high-risk sexual behaviors, and the relationship between sexual behaviors and HPV vaccine non-initiation among survivors. METHODS: Survivors at comprehensive cancer centers, aged 18-26 years and 1-5 years post-treatment, reported sexual behaviors and HPV vaccine initiation (i.e., ≥ 1 dose). Multivariable logistic regression was performed to calculate odds ratios (OR) and 95% confidence intervals (95%CI) for factors associated with high-risk sexual behaviors (age at first intercourse < 16 years, ≥ 3 lifetime sexual partners, or condom use ≤ 50% of the time) and to explore the relationship between sexual behaviors and vaccine non-initiation. RESULTS: Of the 312 participants (48.1% female, median age at cancer diagnosis 17.2 years and at survey 20.9 years), sexual intercourse was reported by 63.1%. Of those reporting intercourse, 74.6% reported high-risk sexual behavior. Factors related to high-risk sexual behavior included currently dating/partnered (OR = 4.39, 95%CI 2.5-7.7, P < 0.001) and perceived susceptibility to HPV (OR = 1.76, 95%CI 1.3-2.5, P < 0.001). Most survivors (75.3%) reported HPV vaccine non-initiation; sexual behaviors were not associated with vaccine non-initiation (P = 0.4). CONCLUSIONS: Many survivors participate in high-risk sexual behaviors, yet HPV vaccine initiation rates are low. Factors related to high-risk sexual behaviors can inform interventions to reduce risk for HPV acquisition among survivors. IMPLICATIONS FOR CANCER SURVIVORS: Cancer survivors participate in sexual behaviors that increase risk for HPV acquisition and would benefit from vaccination.

Parental Self-Efficacy in New Mothers Predicts Infant Growth Trajectories.

The purpose of this study was to examine whether parental self-efficacy (PSE) is associated with change in infant weight-for-length z score (WLZ) from age 3 to 12 months. Data were drawn from the Infant Care, Feeding, and Risk of Obesity study, conducted with low-income, African American mother-infant dyads (n = 127). PSE was measured at infant age of 3 months. Infant anthropometrics were measured at infant age of 3 and 12 months, WLZ change between these time points was calculated, and infants stratified into WLZ change categories (expected, excessive, or slow). To analyze the data, ANCOVA, multiple regression, and post hoc techniques were used. Controlling for infant birthweight, PSE at 3 months was associated with infant WLZ change (η2 = 0.05, p = .04). Mothers of infants who exhibited excessive growth had higher PSE than mothers of infants who exhibited slow growth (Tukey-adjusted p = .03). This finding suggests that infants of mothers with high PSE may have increased obesity risk, but more research is needed.

Sleep following traumatic brain injury (TBI): experiences and influencing factors.

Objective: This study aimed to 1) describe and explore the experiences of sleep following a moderate or severe traumatic brain injury (TBI) in community-dwelling adults, 2) elicit factors that positively or negatively impact the sleep experience, and 3) understand sleep-related education provided to survivors.Design: Qualitative description.Methods: Face-to-face interviews with 16 individuals using a semi-structured interview guide. Transcripts were systematically coded and common themes were identified. The final sample consisted of primarily Caucasian men with average age of 32.4 years (SD = 9.9), and average of 2.6 years (SD = .89) years post injury.Results: Community-dwelling survivors of TBI experienced poor sleep quality and quantity post-injury and described a variety of approaches to manage their sleep. Survivors described coping with sleep changes and using sleep as a coping mechanism for TBI. Additionally, survivors' responses indicated perceived lack of resources and preference for receiving education from knowledgeable, familiar clinicians during face-to-face encounters.Conclusions: This study provides a description of reported sleep experiences following TBI and adds new knowledge regarding sleep management strategies and preferences for resources. The findings suggest a need for education regarding sleep for rehabilitation professionals and long-term sleep support after discharge from rehabilitation.

Decreasing Adverse Events in Pediatric Patients With End-Stage Renal Disease.

Children with end-stage renal disease (ESRD) are at a higher risk of adverse events when they live at a distance from a pediatric facility with specialty services specific to the disease process. At a children's hospital in the southeast, a dialysis unit provides care for 27 patients with chronic ESRD. Nineteen of the 27 patients live more than 1 hour away from the children's hospital. Over the past 3 years, adverse events have occurred in patients being treated at another hospital. These adverse events included sepsis, bacterial and fungal infections, and compromised residual glomerular filtration rate because of the administration of nephrotoxic medications. The purpose of this article is to describe the findings from an improvement effort aimed at decreasing adverse events in the pediatric patient population with ESRD who require urgent or emergent care using an emergency room dialysis card as a communication tool for patients, families, and providers.

Self-efficacy, infant feeding practices, and infant weight gain: An integrative review.

It has been suggested that self-efficacy specific to parenting or feeding may influence the decisions parents make regarding infant feeding; however, a review of this topic has not been conducted. The purpose of this integrative review is to synthesize the literature regarding the potential role of self-efficacy in infant feeding practices or infant weight gain. A total of 40 articles were used to guide this review, which were classified into three categories examining an association with self-efficacy (1) breastfeeding; (2) infant feeding practices such as parental feeding style and dietary quality; and (3) infant weight gain. Evidence regarding breastfeeding self-efficacy (BFSE) and breastfeeding is extensive; mothers with a higher sense of BFSE more often initiate breastfeeding and breastfeed for longer durations. The evidence regarding self-efficacy and the association with infant feeding practices other than breastfeeding is sparse. However, several studies report that mothers who have a higher sense of self-efficacy are more likely to follow infant feeding practices which align with recommendations. The authors have speculated an association between self-efficacy and infant weight gain; yet, to date, no study has found a significant association. More research is needed on the topic, particularly in diverse populations and with fathers and mothers.

Perceptions of Brain Health and Cognition in Older African Americans and Caucasians With HIV: A Focus Group Study.

As people age with HIV, cognitive problems may become more prevalent and severe, but lifestyle behaviors (i.e., physical activity) have been shown to protect brain health and cognition. We examined the perceptions that older adults living with HIV have about protecting and improving brain health and cognition through lifestyle behaviors. Qualitative data were analyzed from four focus groups (N = 30) of African Americans and Caucasians living with HIV and at least 50 years of age. An open-coding scheme using conventional content analysis was employed. Two results were found. First, many older adults with HIV in our study expressed a variety of cognitive complaints that interfered with daily function. Second, these participants reported few specific ideas about how such health behaviors were important to their own brain health and cognition. Education interventions may help older adults with HIV learn to improve and protect brain health and cognition as they age.

Feedback on a Multimodal Cognitive Intervention for Adults Aging With HIV: A Focus Group Study.

Nearly 50% of adult persons living with HIV (PLWH) experience HIV-associated neurocognitive disorder (HAND), which is associated with deteriorating brain health and cognitive functioning. Multimodal interventions that simultaneously improve physical activity, nutrition, and sleep hygiene may be of value for adult PLWH, especially as they age and become vulnerable to HAND. We used four focus groups of PLWH (N = 30; ages ≥ 50 years) to solicit feedback about Cognitive Prescriptions, a multimodal cognitive intervention. Lifestyle and health behaviors pertaining to Cognitive Prescriptions were assessed, including: (a) physical activity, (b) mental activity, (c) nutrition, (d) social engagement, (e) emotional health, (f) sleep hygiene, and (g) substance use. When presented a template of the intervention, participants expressed favorable opinions and remarked they would want to work with a clinician, paraprofessional, or peer to implement such a program into their own daily routines. From this, implications for practice and research are provided.

Development of Participant-Informed Text Messages to Promote Physical Activity Among African American Women Attending College: A Qualitative Mixed-Methods Inquiry.

The purpose of this study was to develop a participant-informed technology-based physical activity (PA) promotion tool for young overweight and obese African American (AA) women. A mixed-method 3-phase study protocol design was used to develop text messages to promote PA in AA women attending the University of Alabama at Birmingham during the Spring of 2013. Nominal focus groups and a 2-week pilot were used to generate and test participant-developed messages. Participants ( n = 14) had a mean age of 19.79 years ( SD = 1.4) and mean body mass index of 35.9 ( SD = 5.926). Focus group data identified key themes associated with the use of text messages to promote PA including message frequency, length, tone, and time of day. Participants preferred text messages that were brief, specific, and time sensitive. Results showed that text messaging was a feasible and acceptable strategy to promote PA in overweight and obese AA women in a university setting.

A Path Analysis of Latino Parental, Teenager and Cultural Variables in Teenagers' Sexual Attitudes, Norms, Self-Efficacy, and Sexual Intentions.

OBJECTIVE: to test a theoretical model based on the Parent-Based Expansion of the Theory of Planned Behavior examining relation between selected parental, teenager and cultural variables and Latino teenagers' intentions to engage in sexual behavior. METHOD: a cross-sectional correlational design based on a secondary data analysis of 130 Latino parent and teenager dyads. RESULTS: regression and path analysis procedures were used to test seven hypotheses and the results demonstrated partial support for the model. Parent familism and knowledge about sex were significantly associated with parents' attitudes toward sexual communication with their teenagers. Parent Latino acculturation was negatively associated with parents' self-efficacy toward sexual communication with their teenagers and positevely associated with parents' subjective norms toward sexual communication with their teenagers. Teenager knowledge about sex was significantly associated with higher levels of teenagers' attitudes and subjective norms about sexual communication with parents. Only the predictor of teenagers' attitudes toward having sex in the next 3 months was significantly associated with teenagers' intentions to have sex in the next 3 months. CONCLUSION: the results of this study provide important information to guide future research that can inform development of interventions to prevent risky teenager sexual behavior among Latinos.

A Path Analysis of Latino Parental, Teenager and Cultural Variables in Teenagers' Sexual Attitudes, Norms, Self-Efficacy, and Sexual Intentions / Análise da trajetória dos pais latinos, variáveis culturais nas atitudes sexuais dos adolescentes, normas, auto-eficácia, e intenções sexuais / Análisis de ruta de padres latinos, adolescente y variables culturales en actitudes sexuales de los adolescentes, normas, autoeficacia e intenciones sexuales

to test a theoretical model based on the Parent-Based Expansion of the Theory of Planned Behavior examining relation between selected parental, teenager and cultural variables and Latino teenagers' intentions to engage in sexual behavior.

testar um modelo teórico com base na Expansão Parental da Teoria do Comportamento Planejado, examinando a relação entre pais selecionados, adolescentes e variáveis culturais e as intenções dos jovens latinos ao se envolverem com comportamento sexual.

poner a prueba un modelo teórico basado en " Parent-Based Expansion " y con base en la teoría del comportamiento planificado para examinar la relación entre los padres seleccionados, adolescente y variables culturales, como también en las intenciones de los adolescentes latinos a participar en el comportamiento sexual.

The multiple stigma experience and quality of life in older gay men with HIV.

Older HIV-infected gay men may experience multiple forms of stigma related to sexual orientation (homonegativity), HIV (HIV stigma), and age (ageism), all of which can negatively impact quality of life (QOL). Our purpose was to determine predictors of homonegativity, internalized HIV stigma, and ageism, and stigma experiences that were predictive of QOL. Sixty HIV-infected gay men, ages 50-65 years, participated. Younger age and emotion-focused coping were significantly predictive of homonegativity, accounting for 28% of variance. Younger age, support group participation, medications per day, social support, and emotion-focused coping predicted internalized HIV stigma, accounting for 35% of variance. Problem-focused coping predicted ageism, accounting for 7% of variance. In regression analysis, the three types of stigma accounted for 39% of variance in QOL (homonegativity 19%, internalized HIV stigma 19%, ageism 0.5%). Study findings may help researchers develop interventions to alleviate multiple stigma experiences of HIV-infected older gay men, thus improving QOL.

Never-pregnant African American adolescent girls' perceptions of adolescent pregnancy.

Despite the decrease in adolescent pregnancy rates, rates among African American girls remain higher than other racial/ethnic adolescent groups. This descriptive qualitative study explored never-pregnant African American adolescent girls' perceptions about adolescent pregnancy. Sixty-four participants participated in individual interviews and focus groups. Individual interviews examined beliefs about adolescent pregnancy and perceptions of life changes resulting from becoming pregnant during adolescence. Focus groups were held to validate findings from the interviews. Participants agreed that becoming pregnant during adolescence would negatively impact their education, family, and peers. Participants anticipated feelings of shame and embarrassment in the event that they became pregnant.

Digital gaming for HIV prevention with young adolescents.

The search for intervention strategies appropriate for young adolescents has recently led to the use of digital games. Digital gaming interventions are promising because they may be developmentally appropriate for adolescent populations. The gaming approach also capitalizes on an inherent interest to adolescents and circumvents traditional barriers to access to prevention interventions faced in some geographical areas. Notwithstanding, research on gaming in HIV prevention is quite limited. In this review article, we examine the need for contextually relevant HIV prevention interventions among young adolescents. From this, we provide a theoretical framework for exploring contextually relevant HIV risk factors and a foundation for gathering and using input from the target population to adapt an existing game or to create a developmentally appropriate and contextually relevant HIV prevention game.

Correlates of condom self-efficacy in an incarcerated juvenile population.

The purpose of this study was to enhance awareness of modes of HIV transmission and increase HIV/sexually transmitted diseases (STD) prevention efforts for incarcerated youth through use of an HIV/STD prevention program guided by the Making Proud Choices! curriculum. A convenience sample of 662 youth aged 13 to 18 was recruited from Alabama juvenile detention facilities. Participants took part in three 2-hour sessions. Baseline and postintervention data were collected. There was no significant difference between males and females in intent to use condoms at baseline and postintervention. Intent to use condoms was the most influential predictor of condom self-efficacy. However, there was little change in condom self-efficacy among males and females at baseline and postintervention.

Support, stigma, health, coping, and quality of life in older gay men with HIV.

As life expectancy for persons living with HIV has increased due to antiretroviral therapy, quality of life (QOL) has become an emerging issue for older gay men with HIV, who comprise more than 50% of older adults living with HIV in the United States. The purpose of this study was to determine predictors of QOL in older gay men with HIV. Sixty gay men ages 50-65 participated. Age, social support, and problem-focused coping were significantly and positively correlated with QOL, while medical comorbidities, social stigma, and emotion-focused coping were all significantly and negatively associated with QOL (p < .01). In stepwise linear regression analysis, emotional/informational support remained as a significant positive predictor, and medical comorbidities, HIV stigma, and emotion-focused coping remained as significant negative predictors, accounting for 64% of the variance in QOL. Study findings may help researchers develop interventions aimed at increasing QOL in this population.

Early adolescent African American girls' perceptions of virginity and romantic relationships.

BACKGROUND: Nationally, African American (AA) girls aged 15 to 19 have the highest incidence of Chlamydia, gonorrhea, and syphilis compared to White and Hispanic girls of the same age group. To address this STI epidemic, it is imperative to target AA girls during early adolescence and before sexual debut. According to the 2011 National Youth Risk Behavior Survey, approximately 7% of AA girls initiate sex prior to age 13. The purpose of this descriptive, qualitative study was to explore AA girls', aged 12 to 14, perceptions about virginity and relationships and how those perceptions influence their decisions to engage in or abstain from sexual activity. METHODS: A convenience sample of 64 participants was recruited through community-based organizations in Alabama. Data were collected using individual interviews and focus groups. Individual interview focused on (1) values and beliefs about being a virgin, (2) choosing boyfriends, and (3) perceptions about good and bad relationships. Focus groups were held to validate findings from interviews. Verbatim transcripts of audiotapes, observation notes, and demographic data were primary data for analysis. Content analysis was used in analysis and interpretation of qualitative data to formulate meaningful categories, themes, and patterns. The qualitative research software, QSR N-Vivo®, was used to code and sort data into categories. The SPSS statistical software was used to conduct descriptive analyses to describe the study sample. RESULTS: Mean age of study sample was 12.9 years. Out of 64participants, 5 reported having engaged in sexual activity. Mean age of sexual debut was 13 years. Common themes that emerged included: respecting myself, ideal boyfriend, characteristics of a romantic relationship. CONCLUSIONS: Findings from this study suggest STI prevention programs should build upon the values related to virginity to promote delaying sexual activity. Furthermore, findings suggest the need for education about healthy relationships.