Student Health Services at Historically Black Colleges and Universities and Predominantly Black Institutions in the United States.

Introduction: Student health services are associated with improved health outcomes and academic success, particularly among under-resourced college populations. This study compared student health services at Historically Black Colleges and Universities (HBCUs) and Predominantly Black Institutions (PBIs) and identified factors associated with the availability of comprehensive health services (CHS). Methods: We conducted a secondary analysis of 2022 data from the Integrated Postsecondary Education Data System (IPEDS), the Minority Serving Institutions (MSIs) Directory, and the websites of HBCUs and PBIs (n=167). Bivariate and multivariate logistic regression analyses were undertaken to identify institutional variables associated with providing CHS. Institutional variables included college type (public vs. private), MSI category (HBCU vs. PBI), undergraduate enrollment, location, and proportion of Pell grant recipients. Results: Approximately 13% of HBCUs and 26% of PBIs offered no student health services; 65% of HBCUs and 39% of PBIs offered on-campus CHS with prescribing providers. Four-year HBCUs were five times more likely than 4-year PBIs to have CHS (p=0.014). Institutions with more Pell Grant recipients were less likely to offer CHS. Conclusions: Access to health care is an important social determinant of health, academic persistence, and achievement for college students. HBCUs were significantly more likely than PBIs to offer CHS. HBCUs are more likely than PBIs to have resources from federal funding, donors, and endowments that may support the development of student health centers and services. Increased funding for PBI health centers could improve access and promote health equity among the most vulnerable student populations.

The influence of pre-college behaviors and parenting practices on alcohol misuse, sexual risk-taking, and adverse outcomes among first-year college women.

OBJECTIVE: Although numerous reports document college students' risk-taking behaviors, few examine these behaviors in a developmental context. The purpose of this study was to examine female freshmen college students' pre-college experiences and parenting influences on first semester experiences with alcohol misuse, sexual risk-taking, and adverse outcomes, including violence. METHODS: We surveyed 229 female freshman residential college students at the end of their first semester in college. RESULTS: Participants who drank frequently in high school were more likely to binge drink in college and regret doing something while drinking. Mother-daughter closeness and parental discussions of sexual risks, personal safety and danger avoidance were associated with a reduced likelihood of regretting doing something while drinking, experiencing sexual violence, and having sex without a condom. Parental provision of alcohol was associated with alcohol misuse. CONCLUSION: These findings provide a life course perspective on the development of risk behaviors and adverse outcomes during emerging adulthood.

A Multi-Center Structural Equation Modeling Approach to Investigate Interpersonal Violence Screening for Public Health Promotion.

Background: Interpersonal violence is a significant public health issue. Routine health screening is a cost-effective strategy that may reduce harmful physical and mental consequences. However, existing research finds consistently low rates of violence screening offered by healthcare providers, e.g., nurses, nurse practitioners, physicians. There is a critical need for research that helps understand how providers' screening behaviors are impacted by individual-level and organizational-level factors to promote the uptake of routine screening for interpersonal violence. Two recent studies, i.e., The Health Care Providers study and Nurse Practitioners Violence Screening study, involved quantitative data collected to measure providers' screening behavior and multi-level factors impacting violence screening. Methods: The current analysis includes a combination of multi-center data collected from The Health Care Providers and Nurse Practitioners Violence Screening studies, respectively. The total sample is 389 providers across the United States. The proposed research develops a system-level multi-center structural equation model framework to rigorously integrate data from the two studies and examine providers' screening behavior for interpersonal violence based upon Theory of Planned Behavior from a quantitative perspective. Results & Conclusions: We successfully examine the efficacy of the Theory of Planned Behavior proposed by Ajzen to predict healthcare providers' screening behavior for interpersonal violence. Organizational factors, e.g., availability of policy for interpersonal violence screening, organizational priority given to violence screening relative to other priorities, and if providers within the health center are interested in improving care quality, were significantly associated with providers' screening behavior. The knowledge and insights generated from our study may facilitate the design and optimization of health professional training and practice environment, and lead to improved women's health and quality of care.

Individual and Institutional Predictors of IPV/SV Screening in College Health Centers.

Intimate partner violence (IPV) and sexual violence (SV) are significant public health issues for women, particularly for college women. IPV and SV have been associated with numerous adverse health consequences and involvement in unhealthy behaviors. Given the health risks and high rates of IPV/SV among college women, it is important to understand and promote screening in this population. The purpose of this study was to examine college women's experiences with IPV/SV screening at college health centers and identify individual and institutional characteristics associated with screening. Random samples of female undergraduate college students from five colleges in the northeast United States were recruited to participate in an anonymous online survey in January 2015. Inclusion criteria included at least one visit to the college health center during the preceding fall semester. Participants were questioned regarding demographics and whether they were screened or asked about IPV/SV at the college health center. A total of 873 women met the inclusion criteria and completed surveys. Only 10.2% of the college women in the study reported that they were screened for IPV/SV at their most recent visit to the college health center. Participants from public colleges/universities were 3 times more likely than others to report screening, whereas participants from urban college/university campuses were more than twice as likely as others to report screening. College women who went to the college health center for a gynecological or sexual health reason were nearly 4 times as likely as other women to report being screened for IPV/SV. Low rates of IPV/SV screening at college health centers represent missed opportunities. Further research across more numerous and diverse college sites is needed to understand the factors that promote or inhibit IPV/SV screening in college health centers to develop interventions to facilitate routine screening practices.

Organizational influences on the intimate partner violence and sexual violence screening practices of college health care providers.

Experts and professional organizations in the U.S. have issued recommendations that health care providers (HCPs) should screen women for intimate partner violence (IPV) and sexual violence (SV). Despite the high rates of IPV and SV experienced by female college students, investigators have found that providers are not screening for IPV and SV in college health centers. In this study, a cross-sectional survey design was utilized to: (a) examine college HCPs' reports of IPV/SV screening behaviors and (b) identify the individual-level and organization-level structure and process characteristics that promote or inhibit IPV/SV screening. A total of 773 college HCPs (physicians, nurse practitioners, and registered nurses) were invited to participate in the study using two separate sampling frames. The final sample included 210 college HCPs. Providers reported low rates of IPV/SV screening (median = 20%). Screening rates varied by provider type with nurse practitioners reporting the highest screening rates. Urban location was associated with a three and one-half times greater likelihood of IPV/SV screening. Use of an electronic health record that included a prompt to screen was associated with a three-fold increase in the likelihood that HCPs would screen for IPV/SV. Further study is needed to better understand how organizational factors influence providers' screening behaviors in college health centers and how these influences are mediated. Future studies should include larger and more diverse samples of colleges and examine geographical variations in screening practices.

Lifetime and Recent Experiences of Violence Among College Women.

INTRODUCTION: Intimate partner violence (IPV) and sexual violence (SV) are serious issues for female college students. Approximately one third of women have experienced physical violence or SV in their lifetime. Female college students experience high rates of both IPV and SV. The purpose of this secondary analysis was to describe the experiences of violence and associated factors reported by college women. METHODS: This secondary analysis included data from a cross-sectional study focused on IPV/SV screening in college health centers. Random samples of female undergraduate students, aged 18-25 years, from five participating universities in the northeastern United States were contacted via email and invited to participate in the study. Eight hundred seventy-three young women met the inclusion criteria and completed survey measures. RESULTS: More than half (52%, n = 457) of female undergraduate students reported having experienced at least one episode of violence in their lifetime. Almost 12% reported experiencing IPV or SV during the preceding semester. For women reporting recent experiences of violence, forced unwanted sexual activities accounted for nearly half of all reported episodes of violence (n = 46). Heavier alcohol drinking on the weekends was correlated with reports of forced sex. DISCUSSION: The results highlight the prevalence of past and recent IPV/SV and increased risk among college women. Further research is needed to identify risk factors of both victimization and perpetration and the milieu of risk on college campuses. Forensic nurses should be key stakeholders in the development and implementation of interventions for violence education, screening, and referral.

Intimate partner and sexual violence screening practices of college health care providers.

BACKGROUND: Female college students experience higher rates of intimate partner violence (IPV) and sexual violence (SV) compared to men of all ages, older women and young women who are not attending college. Experts and medical organizations have issued recommendations that health care providers should routinely screen women for IPV and SV. However, most female college students report they are not being screened for IPV and SV at college health centers. AIM: This exploratory study sought to examine the IPV and SV screening practices of college health care providers and identify individual and organizational influences using a cross-sectional, quantitative survey design. METHODS: Sixty-four health care providers (physicians, nurse practitioners and registered nurses) from five colleges and universities in the northeastern U.S. were invited to participate in an anonymous, web-based survey about their IPV/SV-related screening practices and beliefs, and organizational characteristics of their college health centers. RESULTS: Twenty-six health care providers completed surveys (56% response rate). The median reported IPV/SV screening rate was 15%. More IPV/SV screening was reported by nurse practitioners, providers at state colleges, and by those in health centers that prioritized IPV/SV screening and had greater organizational capacity for change. CONCLUSIONS: College health centers represent unique, yet often missed, opportunities to screen for IPV/SV in a high-risk population. Provider- and organization-level influences should be incorporated into future interventions to improve IPV/SV screening in college health centers. Future studies with larger numbers of colleges and providers are needed to better understand organizational influences and identify mediators and moderators of effects.

The association between discrimination and the health of Sikh Asian Indians.

OBJECTIVE: We investigated the relationships between self-reported discrimination (SRD) and mental and physical health (self-reported physical health conditions and direct, physiologic measures [BMI, waist-to-hip ratio, and blood pressure]) among Sikh Asian Indians (AI), a group that may be particularly discriminated against because of physical manifestations of their faith, including a tendency to wear turbans or ethnic clothing. METHODS: Sikh AIs (N = 196) were recruited from Sikh gurdwaras in Queens, New York. Data were collected on SRD, social support, and self-reported health, along with multiple direct physiological measures for cardiovascular health. RESULTS: Participants who wore turbans/scarves reported higher levels of discrimination than those who did not wear turbans/scarves. As hypothesized, multiple regression analysis supported that discrimination is significantly associated with poorer self-reported mental (B = -.53, p < .001) and physical health (B = -.16, p = .04) while controlling for socioeconomic, acculturation, and social support factors. The study did not support an association between SRD and physiologic measures (elevated BMI, waist-to-hip ratio, and blood pressure). CONCLUSION: Consistent with previous discrimination and health reports, this study demonstrated an inverse relationship between discrimination and health among Sikh AIs, an understudied yet high-risk minority population. Community-based efforts are also needed to reduce the occurrence or buffer the effects of discrimination experienced by Sikh AIs. (PsycINFO Database Record

Relationship Satisfaction and Communication Among Urban Minority HIV-Positive and HIV-Negative Mothers: The Influence on Daughter's Alcohol Use.

Family relationships influence children's beliefs and behaviors. This work examined qualities associated with communication about alcohol among 176 mothers and the influence of this communication on daughters' alcohol use. Path analyses by maternal HIV status indicated significant differences. Relationship satisfaction was associated with self-efficacy for both HIV-positive (ß = 0.545, p < .001) and HIV-negative (ß = 0.557, p < .001) mothers. Maternal self-efficacy was associated with communication for both HIV-positive (ß = 0.364, p < .01) and HIV-negative (ß = 0.310, p < .05) mothers; maternal attitudes toward alcohol use were associated with communication among HIV-negative mothers (ß = 0.20, p < .05). Relationship satisfaction was indirectly related to daughter's alcohol use in HIV-positive dyads (ß = 0.153, p < .05). In families with interfamilial and environmental stressors, investing in the mother-daughter relationship, in part by discussing issues related to alcohol use, is protective in nature.

Experiences and Lessons Learned in Using Community-Based Participatory Research to Recruit Asian American Immigrant Research Participants.

PURPOSE: By 2050, the number of international migrants is expected to double from 214 million people. Of these, Asian immigrants are projected to comprise the largest foreign-born population in the United States by the year 2065. Asian American immigrants experience numerous health disparities, but remain under-represented in health research. The purpose of this article is to examine the experiences and lessons learned in applying community-based participatory research (CBPR) principles to access and recruit a sample of Asian American research participants. APPROACH: This article reviews unique barriers to research participation among Asian Americans, describes the principles of CBPR, and provides examples of how these principles were employed to bridge recruitment challenges within a qualitative study. FINDINGS AND CONCLUSIONS: CBPR facilitated greater research participation among a group of immigrant Asian Americans. Researchers must be additionally mindful of the importance of building trusting relationships with their community partners, understanding the significance of shared experiences, considering fears around immigration status, and considering ongoing challenges in identifying and reaching hidden populations. CLINICAL RELEVANCE: Clinicians and researchers can employ CBPR principles to guide their work with Asian immigrant communities and other under-represented groups to facilitate access to the population, improve participant recruitment, and foster engagement and collaboration.

Screening for Intimate Partner and Sexual Violence in College Women: Missed Opportunities.

BACKGROUND: Intimate partner violence (IPV) and sexual violence (SV) are significant health issues for college women. Leading organizations and experts recommend screening for IPV/SV in health care settings, including college health centers. Given the prevalence and health risks associated with IPV/SV among college women, it is important to examine screening in this population. METHODS: A cross-sectional, web-based survey was administered to college women at two universities in the northeastern United States. The survey consisted of demographic questions, assessment of experiences with IPV/SV (lifetime and past 6 months), use of health care services with either a college health center or an off-campus provider, and assessment of health care setting screening practices. RESULTS: The sample included 615 college women (M = 21.5 years). Lifetime experiences of IPV/SV were reported by 222 women (36.1%). Approximately 8.1% of participants (n = 51) experienced IPV/SV in the past 6 months. Almost 63% (n = 238) reported not being asked about IPV/SV at their most recent off-campus health care visit. Nearly 90% (n = 237) reported not being asked about IPV/SV at their most recent visit to the college health center. CONCLUSIONS: Participants reported high rates of IPV/SV and low rates of violence screening at college health centers and off-campus settings. Routine provider screening for IPV/SV in health care settings can identify women at risk and can lead to interventions that reduce subsequent violence and improve health outcomes and referrals. Theory-based, culture-specific, multilevel interventions are needed to promote IPV/SV screening among college health providers.

Alcohol outlet density and related use in an urban Black population in Philadelphia public housing communities.

Adolescent alcohol use behaviors are influenced by familial patterns and neighborhood factors. This work explored the influence of individual, family, and environment on alcohol use. Baseline data from a randomized controlled trial with Black mothers son dyads (n=382) were paired with census tract and alcohol control board data. Among mothers, younger age, along with neighborhood factors of alcohol outlet density, race, and education were significantly associated with use. Among sons, older age and alcohol outlet density in the neighborhood predicted use. Findings highlight neighborhood influence, beyond family qualities, as a significant determinant of disadvantaged Black mothers' alcohol use. Implications for public health policy are discussed.

Parental influences of sexual risk among urban African American adolescent males.

PURPOSE: This study examined the influence of parental marital status, parent-child sexual communication, parent-child closeness on the HIV-related knowledge, safer-sex intentions, and behaviors of late adolescent urban African American males. DESIGN: The study employed a cross-sectional design with retrospective recall of salient parental influences and behaviors. METHODS: Data were collected via paper-and-pencil questionnaire from 134 late adolescent African American males, 18 to 22 years of age, recruited from urban communities in and around Boston, Massachusetts. Data were analyzed using bivariate correlations, paired t tests, and regression modeling. FINDINGS: Young men reported greater amounts of sexual communication with mothers than fathers (p < .001). Parent-child closeness was positively correlated with amount of parent-child sexual communication with both mothers and fathers (p < .001 for both). Parent-child closeness was, in turn, associated with greater condom use self-efficacy (p < .01), less permissive sexual attitudes (p < .001), fewer sexual partners (p < .01), and less unprotected sex (p < .01). Greater amounts of parent-child sexual communication were associated with fewer sexual risk behaviors, more consistent condom use, and greater intentions to use condoms in the future. There was evidence that parental influences on sexual risk behaviors and condom use intentions were mediated through young men's condom use self-efficacy, attitudes, and beliefs. CONCLUSIONS: These findings highlight the importance of the parent-child relationship and the role of parent-child communication between parents and sons. Further studies are needed to better understand the nature of father-son communication and develop strategies to help parents communicate effectively with sons. CLINICAL RELEVANCE: Evidence has shown that African American adolescent males are more likely to engage in high-risk sexual behaviors. Understanding the sexual risk communication between African American adolescent males and their parents is important to developing strategies in reducing sexual risk behavior.

Characteristics related to sexual experience and condom use among Jamaican female adolescents.

Young women in Jamaica face significant risk for HIV and other STIs. A clearer understanding of the factors associated with sexual experience and unprotected intercourse is needed. Data were collected from 330 adolescent females aged 13 to 17 recruited through community based organizations in Kingston, Jamaica, from 2009-2011. Nearly one-third of sexually experienced participants reported not using a condom the last time they had sex. Characteristics associated with sexual experience included older age, marijuana use, and less comfort talking to mother about sexual topics. Characteristics associated with condom use included perceived importance of religion, positive attitudes toward condoms, and not-having multiple sexual partners. Sexually experienced Jamaican female adolescents were engaging in behaviors that made them vulnerable to HIV and other STIs. Interventions with young adolescent girls and their mothers are recommended to postpone sexual debut and promote safer sexual behaviors in those who do engage in sex.

Maternal HIV serostatus, mother-daughter sexual risk communication and adolescent HIV risk beliefs and intentions.

Daughters of HIV-positive women are often exposed to the same factors that placed their mothers at risk. This cross-sectional study (N = 176 dyads) examined HIV status, parent-teen sexual risk communication (PTSRC), and daughters' abstinence and condom use beliefs and intentions. Maternal HIV status was not associated with PTSRC. Path analyses show that maternal depression was associated with PTSRC behavioral and normative beliefs; relationship satisfaction was associated with PTSRC normative and control beliefs. Control beliefs were solely predictive of maternal PTSRC intention. PTSRC was associated with adolescent behavioral and normative beliefs. Abstinence beliefs were associated with abstinence intentions; condom beliefs were associated with condom use intentions. Relationship satisfaction was associated with adolescent control beliefs about both abstinence and condom use. There is a need for interventions that help HIV-positive mothers recognize their daughter's HIV risk and provide them with relationship building and parent process skills to help reduce these risks.

Obstetric fistula: what about gender power?

Despite over 40 years of research there has been little progress in the prevention of obstetric fistula and women continue to suffer in unacceptable numbers. Gender power imbalance has consistently been shown to have serious implications for women's reproductive health and is known to persist in regions where obstetric fistula occurs. Yet, there is limited research about the role gender power imbalance plays in childbirth practices that put women at risk for obstetric fistula. This information is vital for developing effective maternal health interventions in regions affected by obstetric fistula.

Feasibility of implementing rapid oral fluid HIV testing in an urban University Dental Clinic: a qualitative study.

BACKGROUND: More than 1 million individuals in the U.S. are infected with HIV; approximately 20% of whom do not know they are infected. Early diagnosis of HIV infection results in earlier access to treatment and reductions in HIV transmission. In 2006, the CDC recommended that health care providers offer routine HIV screening to all adolescent and adult patients, regardless of community seroprevalence or patient lifestyle. Dental providers are uniquely positioned to implement these recommendations using rapid oral fluid HIV screening technology. However, thus far, uptake into dental practice has been very limited. METHODS: The study utilized a qualitative descriptive approach with convenience samples of dental faculty and students. Six in-depth one-on-one interviews were conducted with dental faculty and three focus groups were conducted with fifteen dental students. RESULTS: Results were fairly consistent and indicated relatively high levels of acceptability. Barriers and facilitators of oral fluid HIV screening were identified in four primary areas: scope of practice/practice enhancement, skills/knowledge/training, patient service/patient reactions and logistical issues. CONCLUSIONS: Oral fluid HIV screening was described as having benefits for patients, dental practitioners and the public good. Many of the barriers to implementation that were identified in the study could be addressed through training and interdisciplinary collaborations.

An integrative review of relationships between discrimination and Asian American health.

PURPOSE: Many ethnic minorities in the United States experience disproportionate rates of adverse health outcomes or health disparities. Factors such as socioeconomic status do not fully explain how these disparities are generated and maintained. Research has demonstrated that chronic experiences of discrimination are harmful to the health of African Americans and Latinos. However, there is a dearth of research examining Asian Americans' experiences with discrimination and health disparities. The purpose of this integrative review was to summarize the current literature examining discrimination and the mental and physical health of Asian Americans. DESIGN AND METHODS: Combinations of search terms related to discrimination, health, and Asian Americans were used to search five electronic databases. Inclusion criteria were primary research studies, published in English between 1980 and 2011, Asian American adults, and discrimination examined in relationship to a physical or mental health outcome. The search initially yielded 489 results; 14 quantitative studies met inclusion criteria. FINDINGS AND CONCLUSIONS: Quantitative studies in this review revealed several significant associations between discrimination and health outcomes in Asian Americans. Discrimination was significantly associated with depressive symptoms in seven studies. Three studies found associations between discrimination and physical health, including cardiovascular disease, respiratory conditions, obesity, and diabetes. Although the literature was limited by self-reported data, cross-sectional designs, and inconsistent definitions and measurement of discrimination, the findings suggest that discrimination is a significant contributor to poorer health and health disparities for Asian Americans. The findings clearly demonstrate the need for further nursing research in this area to inform evidence-based practice and social policy. CLINICAL RELEVANCE: Patient care providers can recognize discrimination as a significant stressor or purveyor of illness and explore ways to facilitate coping and resilience with their Asian American patients. Community-based participatory research approaches can be implemented by clinicians, academicians, and Asian American community partners to address the issue of discrimination and Asian American health outcomes.

A Qualitative Study of Patients' Attitudes toward HIV Testing in the Dental Setting.

An estimated 1.1 million people in the USA are living with HIV/AIDS. Nearly 200,000 of these individuals do not know that they are infected. In 2006, the CDC recommended that all healthcare providers routinely offer HIV screening to adolescent and adult patients. Nurse-dentist collaborations present unique opportunities to provide rapid oral HIV screening to patients in dental clinic settings and reach the many adults who lack primary medical providers. However, little is known about the feasibility and acceptability of this type of innovative practice. Thus, elicitation research was undertaken with dental providers, students, and patients. This paper reports the results of qualitative interviews with 19 adults attending a university-based dental clinic in New York City. Overall, patients held very positive attitudes and beliefs toward HIV screening in dental sites and identified important factors that should be incorporated into the design of nurse-dentist collaborative HIV screening programs.