Exploring motivations to be active among amputees: a phenomenological approach to leisure time physical activity.

PURPOSE: People with disabilities are less active and experience increased burden of disease compared to those without disabilities. Leisure time physical activity (LTPA) participation is strongly related to improved health in all populations. Despite this, research with amputees focuses heavily on prosthetic design and function, leaving amputees an under-represented population in LTPA and motivation research. This study explored the lived experiences of motivation to engage in LTPA among amputees. METHOD: Interpretative phenomenological analysis (IPA) approach, influenced by understandings of embodiment and Self-Determination Theory (SDT), was used. Six people with lower extremity, acquired amputations created a photo-diary of their motivations to be active and participated in two in-depth interviews each. RESULTS: Study findings suggest motivations to be active among amputees are primarily influenced by personal relationships. Barriers, facilitators, and processes to be active provided insight into how LTPA participation may be affected by more than motivation. Embodiment was experienced as bodily integration of the prosthesis. CONCLUSIONS: There is evidence that the relationship between motivation and participation is not direct, but influenced by facilitators, barriers, and processes to be active. The results suggest strategies to increase activity among amputees by emphasizing LTPA with others, improving the built environment, and ensuring prosthesis fit.

A Sequential Explanatory Mixed Methods Study of Young Adult Tobacco and Marijuana Co-Use.

Background: The co-occurring use of tobacco and marijuana among young adults is an important behavioral phenomenon within the field of substance use. Studying tobacco and marijuana use together among young adults can provide important insight into patterns of initiation and continuation. Objectives: The primary goal of this study was to examine characteristics associated with co-use among young adults and to discover the ways experiences of co-users can help contextualize trends in co-use. Methods: This study employed a sequential explanatory mixed methods design. Quantitative analyses used 12 years of nationally representative National Health and Nutrition Examination Survey (NHANES) data (2005-2016) to assess the characteristics and experiences of young adult (21-30) co-users. Results from analyses of NHANES, prior literature, and theoretical constructs were used to develop a guide for 20 in-depth, semi-structured interviews with young adult co-users living in the state of Maryland. Interviews were analyzed using thematic analysis. Quantitative results and qualitative findings were integrated. The original NHANES analysis occurred during October and November 2017, interviews took place during December 2017 and January 2018, and all mixed methods integration was conducted in 2018. Results: Tobacco and marijuana co-users have unique characteristics and experiences compared to single product users; the experiences of co-users can offer unique insights on co-use. Meta-inferences emerged from integration. Conclusions/importance: Co-users conceptualize tobacco and marijuana differently and hold different risk perceptions for each substance. Co-users may be at risk for polytobacco product use. These findings highlight the profound influence these two substances have on young adult co-users' experiences and behaviors.

Validity and Reliability of the Healthy Families Survey: A Key Component of the Maryland Supplemental Nutrition Assistance Program-Education (SNAP-Ed) Evaluation.

OBJECTIVE: This study established the validity and reliability of the Healthy Families Survey, a 45-item survey measuring nutrition and physical activity behaviors among children and parents enrolled in the Maryland Supplemental Nutrition Assistance Program-Education. METHODS: Analysis included 1,376 pretest surveys. A factor analysis was conducted to establish construct validity, item analyses were conducted to determine item relevance for the target population, and Cronbach α was established to assess internal reliability. RESULTS: The factor analysis extracted 9 factors, with 91% of variables loading appropriately (>+0.30 loading) onto factors. Item analyses identified 6 variables with low (<0.20) or high (>0.80) mean values at baseline. Seven of the 9 subscales had Cronbach α ≥ .60. CONCLUSIONS AND IMPLICATIONS: The Healthy Families Survey demonstrated both strong construct validity and internal reliability and can be used by Supplemental Nutrition Assistance Program-Education agencies to assess child and parent nutrition and physical activity behaviors.

The Dominant Obesity Discourse Versus Children's Conceptualizations of Health: A Comparison Through Dialogue and Drawings.

The emphasis on childhood obesity reduction has been attributed to the dominant obesity discourse. However, some researchers argue that this discourse may be ineffective and even harmful for children. From a post-structuralist perspective, the dominant obesity discourse has the power to shape children's subjectivities, though subjectivities may also be influenced by personal experiences and other knowledge about bodies and health. There is limited research which explores how children's conceptualizations of health are informed by the dominant obesity discourse. To address this knowledge gap, qualitative data were collected from 8- to 11-year-old children ( n = 29) regarding their conceptualizations of health, healthy bodies, and health practices. Results suggest that children's conceptualizations reflected arguments embedded within the dominant obesity discourse, but at times, also contradicted or deviated from it. Study findings can be applied toward children's health promotion programming to offer a more holistic and inclusive perspective on health and well-being.

Understanding Knowledge, Attitudes, and Behaviors Toward West Nile Virus Prevention: A Survey of High-Risk Adults in Maryland.

OBJECTIVE: To assess knowledge, attitudes, and behaviors toward West Nile virus (WNV) prevention among Maryland adults ≥60 years old who are at increased risk of severe WNV disease utilizing the health belief model. METHODS: Using a stratified random sample of households from zip codes with ≥2 human WNV cases, we conducted a telephone survey of 211 Maryland adults ≥60 years old between October and December 2012. RESULTS: Participants expressing worry about WNV were over thrice more likely to use insect repellent in the prior 90 days (adjusted odds ratio [aOR] = 3.46, 95% confidence interval [CI] = 1.33-8.95) and nearly thrice more likely to drain standing water around their homes than those not worried (aOR = 2.86, 95% CI = 1.25-6.52). Respondents perceiving a benefit in paying less for WNV vaccine were more likely to support mosquito control programs (aOR = 16.00, 95% CI = 1.50-170.68). CONCLUSIONS: Future interventions to promote WNV prevention among older adults should seek to enhance perceptions of vulnerability to WNV through risk communication, including media outreach and written messaging, emphasizing the benefits of personal protective behaviors. Community partnerships may aid in outreach to this population.

Affective dysregulation predicts incident nonmedical prescription analgesic use among college students.

INTRODUCTION: This study investigated the relationship between four suspected risk factors-affective dysregulation, conduct problems, depressive symptoms, and psychological distress-and incident nonmedical prescription analgesic (NPA) use among college students. METHODS: The sample was derived from 929 college students from a large, mid-Atlantic university who completed the third annual College Life Study assessment (Y3) and were NPA use naïve at baseline (Y1). A series of logistic regression analyses were conducted to evaluate the predictors of incident NPA use by Y3. Separate models were developed to evaluate the association between the suspected risk factors and (a) NPA use relative to non-use of other drugs, including nonmedical use of other drug classes, (b) NPA use relative to other drug use, and (c) other drug use relative to non-use. All models included gender, parental education level, and race/ethnicity. RESULTS: Affective dysregulation was significantly associated with becoming an incident NPA user relative to both drug users without NPA use as well as non-users, after statistically controlling for demographic characteristics and other factors. Conduct problems in early childhood were positively related to both incident NPA use and other drug use without NPA use relative to non-users, after statistically controlling for demographic characteristics and other factors. Depressive symptoms were associated with NPA incidence at the bivariate level only. CONCLUSIONS: These findings extend previous research suggesting that NPA use might be related to deficits in regulating negative emotional states, and highlight possible markers for screening and intervention to prevent NPA use.

The Relationship Between Health Literacy and Health Conceptualizations:An Exploratory Study of Elementary School-Aged Children.

Analyzing children's conceptualizations of health and body and health literacy will significantly add understanding to how problematic health attitudes and behaviors may take root (Driessnack, Chung, Perkhounkova, & Hein, 2014). The knowledge gained from such an assessment can be applied towards communication contexts that aim to promote children's health literacy and their well-being. With increased health literacy, children can actively participate in decision-making regarding their own health and can understand why healthy behaviors are important to adult health (Borzekowski, 2009). The purpose of this exploratory study was to examine the understudied intersection between health literacy and health conceptualizations in children in order to elaborate on health literacy theory. Specifically, the findings contribute to health communication between children and their caregivers, and between children and health care providers. Qualitative, in depth interviews were conducted with elementary school children. The significance of the study is its contribution to health communication for children, where interventions can consider health literacy types and levels before addressing children's health outcomes. Findings show how we can understand children's conceptualizations and can address health literacy skills inside and out of the classroom in ways that resonate with children.

African American Girls' Ideal Dating Relationship Now and In the Future.

Adolescence is a particularly important and challenging time for developing long lasting romantic relationship patterns. However, limited empirical research has explored teen perceptions of ideal partner characteristics during adolescence or their significance to the quality of current and future relationships. Semi-structured in-depth interviews were conducted with 33 African American high school girls to shed light on the qualities desired in their dating relationships and relational factors that influence teen dating behaviors. Guided by the Social Ecological Framework, interviews were transcribed verbatim and entered into ATLAS.ti, for coding and analysis. Girls discussed the important influence of parents in choosing a partner and provided positive depictions of friendship and marriage with a suitable partner. More research is needed to understand how and why adolescents desire particular characteristics, how socialization shapes teen perceptions and how these preferences may be related to current and future adolescent dating choices, including violence perpetration and victimization.

Teen Dating Violence Victimization, Perpetration, and Sexual Health Correlates Among Urban, Low-Income, Ethnic, and Racial Minority Youth.

This study explores the associations between teen dating violence (TDV) perpetration, victimization, sexual risk behaviors, and pregnancy among a sample of low-income, urban, and predominately African-American and Latino youth age 15 to 21 years ( N = 513). Findings suggest that youth who experienced TDV victimization were more likely to report inconsistent condom use in the past 12 months ( OR = 1.6) and pregnancy ( OR = 2.2) compared with nonvictimized youth. Youth who reported perpetrating dating violence were more likely to be female ( OR = 3.8) and to report multiple sex partners ( OR = 2.0), inconsistent condom use ( OR = 2.6), and prostitution in the past 12 months ( OR = 6.7). TDV perpetration and victimization were highly associated (χ2 = 127.00, p < .001); that is, 30% of the sample reported both victimization and perpetration in their previous or current romantic relationships. Findings from this study highlight the need to integrate culturally informed TDV prevention and intervention strategies into existing adolescent sexual and reproductive health education programs.

The (mal) adaptive value of mid-adolescent dating relationship labels.

The aim of this study was to explore adolescent dating relationships through the prism of high school girls' narratives. We probed the contexts and meanings associated with different forms of dating to better understand the developmental significance of romantic relationships during adolescence. Cross-sectional, in-depth semi-structured interviews were conducted with 20 high school females. The analytic approach was phenomenological and grounded in the narratives rather than based on an a priori theoretical framework. Interviews were digitally recorded, transcribed verbatim by research staff and entered into ATLAS.ti 6, a qualitative data-management software package, prior to analysis. Teen relationships were found to vary along a Dis-Continuum from casual hookups to "official" boyfriend/girlfriend. There was a lack of consensus, and much ambiguity, as to the substantive meaning of different relationships. Labeling dating relationships seem to facilitate acquisition of important developmental needs such as identity, affiliation, and status, while attempting to manage cognitive dissonance and emotional disappointments. Findings underscore the confusion and complexity surrounding contemporary adolescent dating. Adolescent girls are using language and social media to assist them in meeting developmental goals. Sometimes their dating labels are adaptive, other times they are a cause of stress, or concealment of unmet needs and thwarted desires. Programs focused on positive youth development need to resonate with the realities of teens' lives and more fully acknowledge the complicated dynamics of teen dating relationships and how they are formalized, publicized and negotiated.

Medical Students' Beliefs About Screening for Intimate Partner Violence: A Qualitative Study.

Researchers have found that medical students who have received training on intimate partner violence (IPV) report greater comfort with screening for IPV and improved IPV interviewing skills than their counterparts. However, less is known about medical students' beliefs toward screening female patients for IPV and behavioral intention to screen. Semistructured, qualitative interviews were conducted with medical students to assess their beliefs, using the theory of planned behavior and social cognitive theory as theoretical frameworks for the interview questions. Most students felt that screening for IPV could help identify victims but could also potentially offend patients. Perceived barriers to screening included time and negative patient reactions, while perceived facilitators to screening included receiving IPV training and provision of IPV screening questionnaires while interviewing patients. Interviewees identified physicians as both supporters and nonsupporters of IPV screening. Behavioral intention scores ranged from 17 to 50 out of a possible 11 to 55. Findings from the study can help inform the IPV training needs of medical students.

"If you don't have honesty in a relationship, then there is no relationship": African American girls' characterization of healthy dating relationships, a qualitative study.

The quality of dating relationships in adolescence can have long lasting effects on identity development, self-esteem, and interpersonal skills, and can shape values and behaviors related to future intimate relationships. The aims of this study were to: (1) investigate how African American adolescent girls characterize healthy relationships; and (2) describe the meanings of these characteristics in the context of the Centers for Disease Control and Prevention's (CDC) 12 healthy dating relationship qualities. We conducted semi-structured one-on-one in-depth interviews with 33 African American high school girls in the mid-Atlantic region. Trained staff transcribed interviews verbatim and entered the data into ATLAS.ti for coding and analysis. Participants' specified and vividly described eight healthy relationship characteristics: good communication, honesty, trust, respect, compromise, understanding, individuality, and self-confidence. Of these characteristics, three (good communication, compromise, and respect) were described in ways discordant with CDC's definitions. Findings highlight a need to better understand how girls develop values and ascribe characteristics of healthy relationships in order to reduce their risk for teen dating violence.

Ten-year trends in physical dating violence victimization among U.S. adolescent females.

BACKGROUND: The study provides 10-year trend data on the psychosocial correlates of physical dating violence (PDV) victimization among females who participated in the national Youth Risk Behavior Surveys of U.S. high school students between 1999 and 2009. METHODS: The dependent variable was PDV. Independent variables included 4 dimensions: violence, suicide, substance use, and sexual risk behavior. Unadjusted odds ratios (ORs) and 95% confidence intervals (CIs) were examined followed by multivariate logistic regression analyses. RESULTS: Approximately 1 in 10 girls experience PDV annually. PDV among adolescent females is a persistent public health problem despite concerted research and intervention efforts. PDV is associated with a set of psychosocial risk factors, particularly sad/hopeless feelings, suicidal ideation, and physical fighting. CONCLUSIONS: Longitudinal research is needed to improve understanding of the directionality of effects. Efforts need to concentrate on how best to make inroads in terms of primary and secondary prevention.

Adolescent Reports of Aggression as Predictors of Perceived Parenting Behaviors and Expectations.

This study examined the associations between adolescent self-report of aggression and adolescents' perceptions of parenting practices in a sample of African American early adolescents living in low-income, urban communities. Sixth graders (N = 209) completed questionnaires about their aggressive behaviors and perceptions of caregivers' parenting practices at two time points during the school year. Path model findings reveal that adolescent-reported aggression at Time 1 predicted higher levels of perceived parent psychological control and perceived parent expectations for aggressive solutions to conflicts at Time 2. Findings suggest that early adolescent aggression elicits negative parenting behaviors at a subsequent time point.

Drinking motivations and experiences of unwanted sexual advances among undergraduate students.

This study examined the relationship between drinking motivations and college students' experiences with unwanted sexual advances. Undergraduates, from a public university in the mid-Atlantic region, who reported recent (30 day) alcohol use ( n = 289) completed an online survey midway through the spring 2007 academic semester. Experiencing an unwanted sexual advance was the outcome of interest for the present study. The independent variables included sociodemographics and a three-factor (social ease, social image or reputation, emotional distress) drinking motivation measure. Prevalence estimates as well as unadjusted and adjusted odds ratios (OR) were produced. A strong relationship was found between having an unwanted sexual advance and recent binge drinking as well as drinking to remove emotional distress (OR = 3.40 and 2.73, respectively, for the total sample; OR = 7.27 and 2.82 for females). Findings suggest that experiencing an unwanted sexual advance is associated with specific drinking motivations and more likely to occur among females. Further research is needed to fully understand pathways and implications.

10-year trends in physical dating violence victimization among U.S. adolescent males.

This study provides 10-year trend data on the psychosocial correlates of physical dating violence victimization (PDV) among male participants (N = 7,949 in 2009) in the national Youth Risk Behavior Surveys from 1999-2009. Unadjusted odds ratios (OR) and 95% confidence intervals (CI) were examined followed by multivariate logistic regression analyses, which included all significant independent variables from the univariate analyses. Adjusted OR and 95% CI assessed the significance of the relationships. PDV was significantly and consistently associated with feelings of sadness or hopelessness, repeated engagement in physical fighting, current and multiple sex partners, and lack of condom use. A less consistent but noteworthy pattern was found for PDV and gun carrying and cocaine use among adolescent males. PDV is an important public health issue for adolescent males, not just females. There appears to be a set of stable correlates of dating violence victimization among high school males in the United States.

Perceptions of Parenting Practices as Predictors of Aggression in a Low-Income, Urban, Predominately African American Middle School Sample.

This research examined the relation between early adolescent aggression and parenting practices in an urban, predominately African American sample. Sixth graders (N = 209) completed questionnaires about their overt and relational aggressive behaviors and perceptions of caregivers' parenting practices. Findings indicated that moderate levels of parental expectations for peaceful solutions at Time 1 were associated with a lower likelihood of overt aggression at Time 2. Furthermore, findings suggest that when caregivers' support and knowledge of adolescents' whereabouts were relatively low or when caregivers' exerted high psychological control, moderate levels of parental expectations for peaceful solutions protected early adolescents against engagement in both overt and relational aggression. The implications of the findings for schools and other youth violence prevention settings are discussed.

Psychosocial correlates of physical dating violence victimization among Latino early adolescents.

This study examined the association between dating violence victimization and psychosocial risk and protective factors among Latino early adolescents. An anonymous, cross-sectional, self-reported survey was administered to a convenience sample of Latino youth (n = 322) aged 11 to 13 residing in suburban Washington, D.C. The dependent variable was physical dating violence; the independent variables included violence, substance use, emotional well-being, prosocial behaviors, and parenting practices. Multivariate logistic regression models were constructed and adjusted odds ratio and 95% confidence interval were examined. Overall, 13.5% (n = 43) of Latino early adolescents reported being a victim of physical dating violence within the past year. The prevalence was 14.4% for girls and 12.9% for boys. Among the girls, binge drinking was the sole risk behavior associated with dating violence. Gun carrying, alcohol consumption, and having considered suicide were associated with dating violence among the boys. Physical dating violence appears to affect a small but significant proportion of Latino early adolescents and is associated with other risk behaviors. Healthy dating relationship programs are warranted for middle school youth with some tailoring to reflect gender differences in risk profiles.

Psychosocial factors associated with reports of physical dating violence victimization among U.S. adolescent males.

The present study, based upon the national 2005 Youth Risk Behavior Survey of U.S. high school students, provides the most current and representative data on physical dating violence among adolescent males (N = 6,528) The dependent variable was physical dating violence. The independent variables included four dimensions: violence, suicide, subtance use, and sexual risk behavior. Unadjusted odds ratios (OR) and 95% confidence intervals (CI) were examined followed by multivariate logistic regression analyses, which included all significant independent variables from the bivariate analyses. Adjusted OR and 95% CI were computed to assess the significance of the relationships. In terms of prevalence, 10.0% of male adolescents reported experiencing physical dating violence. Boys who reported sad/hopeless feelings (OR = 2.42), physical fighting (OR = 1.92), gun carrying (OR = 1.80), recent sexual partners (OR = 2.84), or unprotected sexual intercourse (OR = 1.81), were more likely to report physical dating violence. These findings suggest that dating violence against adolescent males is sufficiently widespread and clusters with other risk factors, and that further research and intervention efforts be directed toward better understanding and preventing both male victimization and its psychosocial sequalae.

Prevalence and psychosocial correlates of alcohol-related sexual assault among university students.

This study examined the psychosocial correlates of alcohol-related sexual assault. Undergraduate students (N = 551) were recruited to complete a web-based survey. The outcome was a composite of 2 items: "experienced an unwanted sexual advance" or "was the victim of sexual assault or date rape" as a result of another's alcohol use. The predictors were substance use, other alcohol-related interpersonal violence victimization, and alcohol-related protective behaviors. Multivariate logistic regression analyses were conducted. Females reported higher prevalence of alcohol-related sexual assault than did males (20.4% vs. 6.6%). Females who reported binge drinking (OR = 7.74) and other alcohol-related interpersonal violence (OR = 5.03) were more likely to report alcohol-related sexual assault whereas only other alcohol-related interpersonal violence was associated with alcohol-related sexual assault (OR = 43.75) among males. The findings suggest that alcohol-related sexual assault is associated with other risk factors that deserve further attention through longitudinal research and intervention efforts.