Understanding Diabetes Self-Management Among Vietnamese Americans: A Focused Ethnography.

INTRODUCTION: The Vietnamese American (VA) population is projected to grow to 3.9 million by 2030. This demographic shift could affect health care cost as VAs have greater susceptibility for type 2 diabetes mellitus (T2DM). Few studies have explored diabetes self-management (DSM) among VAs. The aim of this study was to explore and describe how VAs with T2DM perceive diabetes and DSM practices. METHOD: A focused ethnographic design, using semi-structured interviews and participant observation, was used to understand DSM among VAs. RESULTS: The following four themes emerged: (a) defining diabetes and its etiology, (b) body awareness as a way of managing diabetes, (c) maintaining strength after being diagnosed with diabetes, and (d) navigating sources of information regarding diabetes. DISCUSSION: The study findings suggest that DSM is a complex and recursive process, with integrations of cultural practices and influences from the environment. These findings can help the development of culturally tailored interventions to assist with DSM.

Evaluation of Fundamental Forensic Knowledge and Perceived Ability in Emergency Nurse Practitioner Education via Forensic Simulation.

INTRODUCTION: The need for trauma care and forensic services is among the top five reasons for seeking healthcare in the United States. Critical aspects of caring for a forensic patient include early recognition of the need for implementing forensic approaches to care: assessment, evidence collection and preservation, and forensic documentation. The intent of this study was to examine fundamental forensic knowledge and perceived ability of graduate-level emergency nurse practitioner students. METHODS: The study was designed to assess fundamental forensic knowledge of graduate-level emergency nurse practitioners using a pretest-and-posttest prospective design utilizing simulation. RESULTS: Students showed an increase in their knowledge of forensic nursing concepts from pretest to posttest (t(39) = 9.63, p < 0.001). In addition, there was an increase in students' perceived ability (confidence) to recognize the forensic aspects of patient care. Two unexpected findings were revealed during debriefing. Although the students were interested in gaining forensic knowledge, they felt it was more important to know when to refer a patient rather than to gain the requisite knowledge to perform forensic functions on their own. Furthermore, students developed an awareness of how their previous clinical experiences influenced their care. CONCLUSION: Findings from this study will inform further development of graduate-level nursing education to include forensic and multidisciplinary simulation exercises.

Engaging Latino Fathers in Children's Eating and Other Obesity-Related Behaviors: a Review.

PURPOSE OF REVIEW: There is a growing evidence of the important role that fathers play in influencing their children's eating and other weight-related behaviors. Latino children are at high risk for obesity and associated medical conditions. Engaging Latino fathers is a potentially important and unique way to help promote healthy lifestyles for Latino children, but doing so requires a culturally sensitive understanding both of fathers' current role and the family perceptions of this role. RECENT FINDINGS: Here, we review recent data and argue that there are subtle but important differences between the qualitative and quantitative research conducted regarding the role Latino fathers may play in promoting healthy eating and physical activity for their children. We suggest how to synthesize these findings and also present qualitative results for ways to best engage Latino fathers in research studies with a focus on physical activity. Results from the review support that Latino fathers are important potential targets for child obesity prevention, but our findings stress the importance of considering cultural values when trying to recruit, engage and retain Latino fathers for such research.

Randomized Controlled Trial to Prevent Infant Overweight in a High-Risk Population.

OBJECTIVES: Infants are at risk of overweight. Infant overweight predisposes child, adolescent, and adult to obesity. We hypothesized that parent education, initiated prenatally and provided in the home, would reduce the incidence of infant overweight at age 12 months. METHODS: Pregnant obese Latina women were recruited at Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and randomized to intervention versus control. Intervention subjects received home visits by trained Spanish-fluent community health workers who provided counseling on infant growth, breastfeeding, nutrition, child development, sleep, physical activity, and safety. Promotoras did not visit the control subjects. A research assistant collected outcome data on all subjects. RESULTS: Compared to controls, parent education did not reduce infant overweight. Infant overweight developed rapidly and was present in 46% of infants by age 6 months. Infants overweight at 6 months were likely to be overweight at age 12 months (r = 0.60, P < .0001). Overweight was more common in formula-fed infants at ages 6 months (P < .06) and 12 months (P = .005). Breastfeeding was less common in families with employed mothers (P = .02) and unemployed fathers (P < .01), but the father living with the mother at the time of the prenatal visit predicted successful breastfeeding at infant age 2 months (P < .003). Compared to formula feeding, overweight at age 12 months was 2.7 times less likely for infants breastfed for ≥2 months (P = .01). CONCLUSIONS: The lack of success of the intervention may be explained in part by a high cesarean section rate in the intervention group, food and employment insecurity, and confounding by WIC breastfeeding promotion, which was available to all mothers. Breastfeeding was the most important mediator of infant overweight. The study supports efforts by WIC to vigorously promote breastfeeding.

Relationship of Sleep Duration and Regularity with Dietary Intake Among Preschool-Aged Children with Obesity from Low-Income Families.

OBJECTIVE: Diet is a modifiable factor associated with pediatric obesity outcomes, but few studies have evaluated the relationships of sleep duration and regularity on dietary intake of young preschool-aged children. The goal of this study was to evaluate whether short sleep duration and irregular sleep timing were associated with greater calorie, carbohydrate and fat consumption among young children with obesity from low-income families. METHODS: Fifty-one ethnically diverse children aged 2 to 4 years were recruited from the Special Supplemental Nutrition Program for Women, Infants, and Children clinics in a southeast Texas county. Sleep behaviors were parent reported using the Child Sleep Assessment tool. Dietary intake data were obtained by 24-hour recall interviews (2 weekdays and 1 weekend day). RESULTS: Short sleep duration (<11 hr) was highly prevalent among this cohort of preschool-aged children. Short sleep duration was associated with greater fat and decreased carbohydrate consumption. Children with greater variability in sleep duration and timing had greater energy intake from fat and protein sources. CONCLUSION: Allowing for the opportunity to educate parents on the importance of maintaining regular, adequate sleep and relationships between sleep and dietary intake may decrease the risk of childhood obesity in this high-risk pediatric population.

How Did They Grow: An Intervention to Reduce Stunted Growth in Low-Income Mexican-American Children.

Growth stunting is a complex phenomenon related to undernutrition that can contribute to developmental delay, cognitive deficits, and small size and obesity in adulthood. Stunted growth, defined as height for age below the 5th percentile, is primarily caused by chronic malnutrition. In this study, a community-based intervention to reduce undernutrition was tested in a quasi-experimental design with 174 low-income, Mexican-American mothers and children recruited from a Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) clinic in a major southwestern city. The intervention was based on the public health nursing practice of collaborating with mothers of young children on appropriate nutrition and parenting, and was tailored by the author and community informants for mothers of children with stunted growth. Data were collected on child height and weight, dietary intake, maternal acculturation, maternal perceived stress as measured by the Perceived Stress Scale (PSS), home environment as measured by the home screening questionnaire (HSQ), and maternal-child interaction as measured by the Nursing Child Assessment Teaching Scale (NCATS). Intervention children had higher growth velocity than the children in the comparison group. These findings were especially prominent for children of women who were older and less acculturated. Results suggest that a nursing intervention delivered in collaboration with WIC can make a significant improvement in growth of low-income children with growth stunting.

Adapting and Integrating Photovoice in a Baccalaureate Community Course to Enhance Clinical Experiential Learning.

BACKGROUND: The adaptation and incorporation of photovoice--a qualitative research method--into the Community Health Nursing clinical course to foster students' clinical reasoning in a community setting is presented. METHOD: Photovoice was used as a teaching strategy in the windshield survey and key informant interview activities that are part of the community health clinical experience. Students were provided with disposable cameras and were instructed to take photographs of the community. RESULTS: Students shared the photographs with faculty and community members and explored ways of developing sustainable community-based interventions that promote and protect health. CONCLUSION: Photovoice can be used as a teaching strategy tool in any clinical course to foster experiential learning.

Are physical activity studies in Hispanics meeting reporting guidelines for continuous monitoring technology? A systematic review.

BACKGROUND: Continuous monitoring technologies such as accelerometers and pedometers are the gold standard for physical activity (PA) measurement. However, inconsistencies in use, analysis, and reporting limit the understanding of dose-response relationships involving PA and the ability to make comparisons across studies and population subgroups. These issues are particularly detrimental to the study of PA across different ethnicities with different PA habits. This systematic review examined the inclusion of published guidelines involving data collection, processing, and reporting among articles using accelerometers or pedometers in Hispanic or Latino populations. METHODS: English (PubMed; EbscoHost) and Spanish (SCIELO; Biblioteca Virtual en Salud) articles published between 2000 and 2013 using accelerometers or pedometers to measure PA among Hispanics or Latinos were identified through systematic literature searches. Of the 253 abstracts which were initially reviewed, 57 met eligibility criteria (44 accelerometer, 13 pedometer). Articles were coded and reviewed to evaluate compliance with recommended guidelines (N = 20), and the percentage of accelerometer and pedometer articles following each guideline were computed and reported. RESULTS: On average, 57.1 % of accelerometer and 62.2 % of pedometer articles reported each recommended guideline for data collection. Device manufacturer and model were reported most frequently, and provision of instructions for device wear in Spanish was reported least frequently. On average, 29.6 % of accelerometer articles reported each guideline for data processing. Definitions of an acceptable day for inclusion in analyses were reported most frequently, and definitions of an acceptable hour for inclusion in analyses were reported least frequently. On average, 18.8 % of accelerometer and 85.7 % of pedometer articles included each guideline for data reporting. Accelerometer articles most frequently included average number of valid days and least frequently included percentage of wear time. DISCUSSION: Inclusion of standard collection and reporting procedures in studies using continuous monitoring devices in Hispanic or Latino population is generally low. CONCLUSIONS: Lack of reporting consistency in continuous monitoring studies limits researchers' ability to compare studies or draw meaningful conclusions concerning amounts, quality, and benefits of PA among Hispanic or Latino populations. Reporting data collection, computation, and decision-making standards should be required. Improved interpretability would allow practitioners and researchers to apply scientific findings to promote PA.

Sleep duration and its association with ambulatory blood pressure in a school-based, diverse sample of adolescents.

BACKGROUND: Evidence is accumulating that sleep duration is related to blood pressure (BP) and hypertensive status, but the strength of the association varies by age, and findings are inconsistent for adolescents. This cross-sectional study tested the hypothesis that sleep duration, both during the night and during naps, would be negatively associated with ambulatory systolic BP (SBP) and diastolic BP (DBP) measured over 24 hours in adolescents. METHODS: In this ethnically diverse (37% non-Hispanic black, 31% Hispanic, 29% non-Hispanic white, 3% other), school-based sample of 366 adolescents aged 11-16 years, ambulatory BP was measured every 30 minutes for 24 hours on a school day; actigraphy was used to measure sleep duration. Covariables included demographic factors, anthropometric indices, physical activity, and position and location at the time of each BP measurement. Mixed models were used to test day and night sleep duration as predictors of 24-hour SBP and DBP, controlling for covariables. RESULTS: The mean sleep duration was 6.83 (SD = 1.36) hours at night, and 7.23 (SD = 1.67) hours over 24 hours. Controlling for duration of sleep during the day and covariables, each additional hour of nighttime sleep was associated with lower SBP (-0.57; P < 0.0001); controlling for nighttime sleep duration and covariables, each additional hour of daytime sleep was associated with lower SBP (-0.73; P < 0.001) and lower DBP (-0.50; P < 0.001). CONCLUSIONS: Longer sleep duration was significantly associated with lower ambulatory SBP and DBP in adolescents. The findings have potential implications for cardiovascular health in this age group.

Solving the obesity epidemic: voices from the community.

"Science and Community: Ending Obesity Improving Health" (S&C) aimed to reduce obesity in Houston by developing community partnerships to identify research priorities and develop a sustainable obesity reduction program. Partnership members were recruited from S&C events and invited to participate in in-depth interviews to gain insight into obesity prevalence, causes, and solutions. Members (n = 22) completed a 60-90-min in-depth interview. The interview guide consisted of 30 questions about pressing health problems in the community, potential solutions to health problems and obesity and how the environment has impacted obesity and health behaviors in the community. Interviewees (n = 12 women and 10 men) were mostly Hispanic/Latino (n = 9) and African American (n = 7). Common problems identified were childhood obesity, balancing a healthy diet and physical inactivity. Interviewees identified obesity as a major problem in their communities and cited access to quality food and physical activity resources as both a problem and a solution. Additional emergent themes focused on solutions, including increasing awareness and education, coordinated efforts among organizations and using an ecologic approach to combat obesity. Community insight gleaned from this study may be used to enhance relevance and sustainability of programs developed to reduce obesity and suggests possible avenues for participatory research and intervention.

Achieving long-term weight maintenance in Mexican-American adolescents with a school-based intervention.

PURPOSE: This study evaluated 24-month outcomes of a school-based intensive lifestyle weight management program targeting overweight Mexican-American adolescents. METHODS: We recruited a total of 71 adolescents (32 males; 45.1%) between the ages of 10 and 14 years, at or above the 85th percentile for body mass index (BMI). Participants were randomized to a 6-month instructor-led intervention (ILI) or a self-help (SH) program. Both interventions were aimed at modifying eating and physical activity behaviors using behavior modification strategies. We assessed changes in participants' standardized BMI and BMI percentile at baseline, 1, and 2 years. RESULTS: Repeated-measures analyses showed that ILI participants showed significantly greater decreases in standardized BMI at 1 and 2 years (F = 8.58, p < .01; and F = 9.27, p < .01, respectively) compared with SH controls. Similar results were found for changes in BMI and BMI percentile. At 2 years, the ILI condition decreased their average BMI percentile by 3.9 percentile points, compared to an increase of 1.6 percentile points in the SH condition. CONCLUSIONS: A school-based intervention resulted in improved weight outcomes in overweight Mexican-American adolescents and results were maintained over 2 years.

Impact of a school-based pediatric obesity prevention program facilitated by health professionals.

BACKGROUND: This study evaluated a school-based obesity intervention for elementary school children (N = 835) where health professionals assisted teachers with the integration of healthy messages into the school curriculum. METHODS: Schools were randomized into a professional-facilitated intervention (PFI; N = 4) or a self-help (SH; N = 3) condition. Changes in weight-based outcomes were assessed in students enrolled in the second grade from all 7 schools (overall: N = 835 students; PFI: N = 509 students, SH: N = 326 students). Students were between ages 7 and 9 and from diverse ethnic backgrounds (Asian = 25.3%, Black = 23.3%, Hispanic = 23.1%, White = 28.3%). The sample included 321 overweight/obese (BMI ≥ 85th percentile), 477 normal-weight (BMI ≥ 5th percentile and <85th percentile), and 37 underweight (BMI < 5th percentile) students. RESULTS: After 2 years, children who were overweight/obese in the PFI condition significantly reduced their standardized BMI (zBMI) compared to children in the SH condition (Wald χ(2) = 28.7, p < .001). End-of-year grades decreased for overweight/obese students in both conditions; however, students in the PFI exhibited a smaller decrease in grades compared to the SH condition (Wald χ(2) = 80.3, p < .001). CONCLUSION: The results indicate that an obesity prevention program where health professionals assist teachers by integrating healthy messages into existing curriculum was effective in reducing zBMI compared to the SH condition.

Smaller weight changes in standardized body mass index in response to treatment as weight classification increases.

OBJECTIVES: To compare the differential efficacy of a weight loss program for Mexican-American children who are overweight, obese, and severely obese. STUDY DESIGN: Study participants were enrolled in an intensive weight loss intervention aimed at improving eating and physical activity behaviors with behavior modification strategies. Participants included 212 children (45% female) between the ages of 9 and 14 (mean = 12.0, standard deviation = 0.7). All participants were classified as overweight, obese, or severely obese. RESULTS: Repeated measures analyses revealed that children in the overweight, obese, and severely obese weight categories differed significantly in standardized body mass index (zBMI) decreases at baseline, 3, 6, and 12 months (F = 4.57, P < .01, η(p)(2) = .06). Follow-up paired samples t tests showed a significant change in zBMI from baseline to 3 and 6 months for children in the overweight, obese, and severely obese weight categories. However, at 12 months only the overweight and obese students continued to show significant improvement from baseline in zBMI. CONCLUSIONS: These findings suggest that an intensive behavioral weight loss intervention that has demonstrated efficacy for decreasing zBMI may have incrementally smaller effects for children as weight classification increases.

Maternal perspectives on lifestyle habits that put children of Mexican descent at risk for obesity.

PURPOSE: This article presents the views that mothers of Mexican descent have related to lifestyle habits that put children at risk for obesity. DESIGN AND METHOD: A qualitative, naturalistic design using ethnographic interviews was selected for this study. Informational redundancy was reached with 9 mothers of Mexican descent. Spradley's Developmental Research Sequence guided data collection and analysis. RESULTS: Participants held views that were congruent with the American Academy of Pediatrics' recommendations. PRACTICE IMPLICATIONS: Findings provide nurses with knowledge on how mothers of Mexican descent view appropriate nutrition, discipline in feeding, and the place of physical activity and television in young preschool children's lives.

Home-based injury prevention practices used by mothers of Mexican descent living in San Antonio, TX.

PURPOSE: To describe the home-based injury prevention practices used by low-income mothers of Mexican descent with their preschool children. DESIGN AND SAMPLE: A descriptive qualitative study with convenience sampling of mothers (n=9) who are of Mexican descent and have preschool children. METHOD: Data collection consisted of ethnographic interviews supplemented by focused home observations. RESULTS: 2 themes emerged from the data: the spectrum of physical proximity and the use of injury prevention technology. The spectrum of physical proximity reflected the degree of physical closeness (i.e., supervising children, watching children closely, and being after children) that the mothers used to manage injury risk in their children. Children who were perceived as curious or restless, or too young were judged by the mothers as being prone to injury and requiring more maternal physical closeness. The participants used the injury prevention technology recommended by the experts despite their limited economic resources. However, this group of mothers used the spectrum of physical proximity as the main tool to prevent child injuries in their home. CONCLUSION: These findings provide an insight into the attitudes and behaviors of low-income, Mexican mothers toward injury prevention in the home. Awareness of these attitudes and behaviors will allow for the creation of interventions that take into account this maternal perspective.

Child health promotion and protection among Mexican mothers.

For numerous reasons, children of Mexican descent experience many health disparities. One strategy for addressing these disparities is to increase health promotion and protection behaviors that mothers use with their preschool children. Limited literature is available on such practices used by mothers of Mexican descent with their healthy preschool children. This study explored child health promotion and protection practices used by mothers of Mexican descent. A naturalistic design, guided by Spradley's ethnographic interview techniques, was selected for this study. The sample included 9 Mexican-descent mothers from an urban U.S. community with healthy preschool children. Despite significant challenges, participants promoted and protected the health of their preschool children by al cuidado (taking care) and by being al pendiente (being mindful) of balancing the health of their children's bodies, minds, and souls. Understanding these mothers' approaches allows the creation of culturally sensitive health programs that can build on existing maternal strengths.

Factors related to overweight and risk for overweight status among low-income Hispanic children.

The purpose of this research was to investigate the agent, host, and environmental factors that are related to overweight status in a sample of low-income Hispanic toddlers who were enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children in a large southwestern city in the United States. Among children at risk for overweight status, the mothers' body mass index (BMI) and the number of servings of fat in the children's daily diet were positively associated with their weight/height percentiles whereas servings of protein in the daily diet and the children's reporting of hunger were negatively associated with their weight/height percentiles. Among overweight children, age was positively associated with their weight/height percentiles. No other variable in the ecological model was associated with normal weight or overweight children and their weight/height percentiles. Different approaches to dietary counseling and health promotion may be indicated based on a child's weight/height percentile or BMI.

Using ecological models in research on health disparities.

Ecological models of human interaction can be used to study complex community problems that affect health disparities. These models allow researchers to study the components of a problem and understand how the problem can be ameliorated with nursing interventions. This article describes four research studies in which ecological models were used to either understand a phenomenon or design and test an intervention. The methods used were ethnography, descriptive/correlational, and quasi-experimental. All subjects were low-income women and children, largely of Hispanic ethnicity, residing in South Texas. The ecological models were derived from Bronfenbrenner's ecology of human development theory, epidemiology, Rubin's theory of developmental tasks of pregnancy, and Barnard's model of mother-child interaction. Heuristic models that represent reality allow researchers to divide a complex problem, such as health disparities, into manageable components. The influence of families, neighborhoods, and communities can be considered without losing sight of individuals.