Evaluating Critical Thinking Disposition, Emotional Intelligence, and Learning Environment of Nursing Students: A Longitudinal Study.

BACKGROUND: The COVID-19 pandemic may have inhibited the development of critical thinking and emotional intelligence of nursing students due to the transition from traditional to online learning environments. OBJECTIVE: The objective was to evaluate the development of critical thinking, emotional intelligence, and the perceived learning environment of nursing students during the pandemic from their first to second year. METHODS: This was a longitudinal study of 82 nursing students from 2 universities in Greece. We measured critical thinking disposition, emotional intelligence, and the students' perceptions of the learning environment in 2 phases, separated by a 10 month interval, before and during the pandemic. RESULTS: Students had moderate-to-high critical thinking and emotional intelligence and perceived the learning environment as more positive than negative in both phases. However, there were no statistically significant changes between phases in critical thinking disposition (mean score 44.3 vs 45.1, p = .224) and emotional intelligence (mean score 5.05 vs 5.06, p = .950) between the 2 phases. Nevertheless, students rated the online learning environment (phase 2) higher than the traditional (mean score 137.8 vs 132.2, p = .005). CONCLUSIONS: Critical thinking and emotional intelligence did not change, but students favored the online learning environment over the traditional. These findings suggest that nurse educators persevered, adapted, and maintained the quality of the learning environment despite the pandemic. Moreover, the utilization of an online learning environment may have led to enhanced enjoyment and engagement for students, which could potentially result in improved learning outcomes.

Intention, Motivation, and Empowerment: Factors Associated with Seasonal Influenza Vaccination among Healthcare Workers (HCWs).

BACKGROUND: Vaccination against seasonal influenza has proven effective in preventing nosocomial influenza outbreaks among hospital patients and healthcare workers (HCWs). This study aims to explore the intention, motivation, and empowerment toward vaccination and vaccination advocacy as contributing factors for seasonal influenza vaccination in HCWs. METHODS: A cross-sectional study in eight secondary hospitals in Greece was conducted from March to May 2022. An anonymous questionnaire was enclosed in an envelope and distributed to all participants, including questions on vaccine behavior and the MoVac-flu and MoVad scales. RESULTS: A total of 296 participants completed the questionnaire. In multivariate logistic regression models adjusted for potential confounders, increased age, intention score, MoVac-flu scale score, and the presence of chronic diseases were significant predictors of influenza vaccination this year, while increased age, intention score, and presence of chronic diseases were predictors of vaccination every year. CONCLUSION: Vaccination uptake is simultaneously affected by logical cognitive processes (intention), together with factors related to motivation and empowerment in distinct self-regulatory domains such as value, impact, knowledge, and autonomy. Interventions focused on these identified predictors may be used as a guide to increase HCWs' vaccination rates.

Linking Learning Environment and Critical Thinking through Emotional Intelligence: A Cross-Sectional Study of Health Sciences Students.

BACKGROUND: Health sciences educators should increase the critical thinking of their students as this may improve the quality of care. However, this is rarely considered as a critical point in teaching, despite studies identifying factors such as the learning environment and emotional intelligence as increasing critical thinking at an undergraduate level. Thus, there is a need to better explore these factors and investigate interrelations and ways of improving critical thinking, especially in the critical field of healthcare students (nursing and medicine). OBJECTIVES: The present study aimed to examine the potential relationships between critical thinking with emotional intelligence and the learning environment. METHOD: This was a descriptive cross-sectional study with 208 first year health sciences university students of two nursing departments and one medicine department from three universities in Greece. The Critical Thinking Disposition Scale, Dundee Ready Education Environment Measure, and Trait Emotional Intelligence-Short Form questionnaires were used to assess critical thinking, the education environment, and emotional intelligence, respectively. RESULTS: The results demonstrate that critical thinking was positively related to emotional intelligence (ß = 0.82, p < 0.001), but not to the learning environment (ß = 1.06, p = 0.30). However, a structural equation modeling analysis supported the indirect relationship between the learning environment and critical thinking through emotional intelligence (M = 1.10, CI = 0.13-2.17, p < 0.05). CONCLUSIONS: Emotional intelligence may be the underlying mechanism for achieving critical thinking if it is well applied and cultivated in a learning environment. Therefore, universities could modify their curricula and place emotional intelligence at the epicenter of teaching.

Emotional intelligence is more important than the learning environment in improving critical thinking.

PURPOSE: To examine the association of critical thinking (CT) and emotional intelligence (EI) versus CT and learning environment (LE) in order to investigate which has the greatest influence EI or LE. MATERIALS AND METHODS: A cross-sectional study was conducted with 340 s-year healthcare university students in two nursing and one medical schools from three universities in Greece, between October and December 2020. Critical Thinking Disposition Scale, Dundee Ready Education Environment Measure, and Trait Emotional Intelligence Questionnaire-Short Form were administered. Hierarchical multiple linear regression analysis, with five steps, was used to compare the associations of CT and EI to CT and LE. RESULTS: Participants' mean age (years) was 20.9 (6.6 SD); 82.6% female; 86.8% studying nursing. Students mean scores were moderate to high for CT disposition (44.7 ± 4.68). The general characteristics (age, gender, and school) were not significantly associated with CT (p > 0.05). However, CT was positively associated with LE (UCB = 0.064 & p < 0.001) and EI (UCB = 1.522 & p < 0.001). Moreover, CT seems to be associated in a higher degree (R2 change adj = 0.036 & p < 0.001) with emotional intelligence (UCB = 1.522) than with learning environment (UCB = 0.064). CONCLUSIONS: Our findings suggest a different more optimal pathway for educators to improve the CT of their students through EI and not with LE as believed till now. By focusing on improving EI, educators may help their students become critical thinkers, who will provide better quality of care.

Improving Critical Thinking in New Graduate Nurses: Are Practical Methods the Answer?

Critical thinking is an essential skill of health care professionals. Not sufficiently matured during undergraduate studies, critical thinking skills need continued development. One solution could be a practical guide of teaching methods for clinical educators and professional development specialists to use with new graduate nurses. This column describes a few practical methods that can improve critical thinking. [J Contin Educ Nurs. 2022;53(12):530-532.].

Nursing practice environment and employee silence about patient safety: The mediating role of professional discrimination experienced by nurses.

AIMS: To examine the associations between nurse work environment with nurses' silence about patient safety and the mediating effects of professional discrimination experienced by nurses. DESIGN: Multicentre cross-sectional study. METHODS: Between January and April 2019, 607 nurses and nursing assistants from seven hospitals in Greece assessed their clinical environment using the 'Practice Environment Scale of the Nursing Work Index Revised-PES-NWIR', and the silence about patient safety. The 'Experiences of Discrimination Index' was adapted to specifically address experienced discrimination based on the nursing profession. The PROCESS macros for SPSS were used to examine the above associations. FINDINGS: Better nurse practice environment, with the exception of 'staffing and resource adequacy' dimension, was directly associated with less experienced professional discrimination, and directly and indirectly associated with less silence about patient safety, through the mediating role of professional discrimination experienced by nurses. CONCLUSIONS: Silence about patient safety is dependent on the clinical work environment and may be a response of nurses to discrimination in the work context. Both an improvement in the nurse work environment and a decrease in professional discrimination would minimize silence about patient safety. IMPACT: On many occasions, nurses are directly or indirectly discouraged from voicing their concerns about patient safety or are ignored when they do, leading to employee silence and decreasing the standard of care (Alingh et al., BMJ Quality & Safety, 2019, 28, 39; Pope, Journal of Change Management, 2019, 19, 45). Nurses' work-related determinants for silence are not clearly understood in the patient safety context. A favourably evaluated nurse practice environment is associated with less experienced professional discrimination and less silence about patient safety. To minimize silence about patient safety, both the nurse work environment and the experienced professional discrimination should be taken into consideration by nurse and healthcare managers.

Harmonious work passion and work-related internet information seeking among nurses: The mediating role of intrinsic motivation.

AIM: The aim of this study is to investigate the relationship between nurses' harmonious work passion and work-related internet information seeking. In doing so, we examine intrinsic motivation as an underlying mechanism of this relationship. BACKGROUND: Nurses seek and utilize information to respond effectively to their tasks and to develop their skills and competencies. Internet consists one of the easiest and richest sources of information. Both nurses and organizations need to identify potential antecedents of work-related internet information seeking. METHODS: Data were collected from 239 nurses and nurse assistants in a Greek University hospital and were analysed using bootstrap analysis with PROCESS macro. RESULTS: Harmonious work passion was positively related to intrinsic motivation and intrinsic motivation related positively to work-related internet information seeking. The mediating role of intrinsic motivation was also supported. CONCLUSIONS: Nurses with harmonious work passion seek more regularly work-related information on the internet because they experience high levels of intrinsic motivation. IMPLICATIONS FOR NURSING MANAGEMENT: Health care organizations and managers need to recruit passionate nurses and cultivate a workplace culture that will trigger higher levels of harmonious work passion. Recruitment tools and methods such as interviews, situational judgement tests or role playing could be very beneficial towards uncovering potential candidates with an elevated passion for their work.

Nurses' ehealth literacy and associations with the nursing practice environment.

AIM: To report on ehealth literacy levels in nurses and to explore its associations with the nursing practice environment. BACKGROUND: Nurses increasingly use the Internet and associated technologies to seek health-relevant information and manage their health. INTRODUCTION: High ehealth literacy is a predictor of better health outcomes in diverse populations but its levels and work-related determinants have not been adequately explored in direct-care nurses. METHODS: The sample for this cross-sectional study consisted of 200 staff nurses and nursing assistants in Greece. Participants reported during February-March 2019 their sociodemographic and work-related characteristics on a self-administered questionnaire which included the "electronic Health Literacy Scale"-eHEALS, and the "Practice Environment Scale of the Nursing Work Index"-PES-NWI. Crude and adjusted logistic regressions were performed. FINDINGS: In adjusted models, participants that scored higher on the "Collegial nurse-physician relationships" and "Nurse participation in hospital affairs" dimensions of the clinical environment had higher odds of reporting better ehealth literacy. The lowest item score in eHEALS was related to not being able to make health decisions using Internet information. DISCUSSION: Nurses' ehealth literacy was positively associated with some dimensions of the hospital practice environment. Nurses reported higher ehealth literacy scores in comparison to other studies; however, they were not confident in distinguishing reliable health information from Internet sources. This is quite alarming because it can directly impair the ability of nurses to provide relevant and up-to-date evidence-based care. CONCLUSION: This is the first study to report internationally on the positive associations of a good working environment with nurses' ehealth literacy levels. IMPLICATIONS FOR NURSING AND NURSING POLICY: Nursing policy should address the ehealth literary of nurses and integrate it into continuing professional education initiatives. Special focus should be put on nurses' ambiguity in distinguishing which ehealth information is reliable and can guide nursing practice. This should be combined with efforts to improve the nursing clinical environment and increase nurses' participation in hospital decisions.

A longitudinal study of multiple lifestyle health risk behaviours among nursing students and non-nursing peers.

AIM: The aim of this paper is to compare the evolution of health risk behaviours between undergraduate nursing and social work students. BACKGROUND: Nursing includes the promotion of health and the shaping of healthy behaviours. An important determinant for providing lifestyle advice is the lifestyle of nurses themselves. DESIGN: Longitudinal comparative study. MEASUREMENTS: We compared lifestyle risk behaviours (binge drinking, cannabis/hashish/marijuana use, smoking, oral hygiene/toothbrushing, breakfast/fruit/vegetable consumption, physical activity and screen time/sedentary behaviours) using a self-administered standardized questionnaire in nursing (n = 121) and social work (n = 140) students at the beginning (2012) and the end of their studies (2015). Adjusted multivariable logistic/Poisson regression models were performed. RESULTS: There were no statistically significant differences between the departments in most risk factors in both assessments. However, in relation to their first year, both nursing and social work students displayed higher relative risk of engaging in more behavioural risk factors at the end of their studies (in delivery/junk food consumption, sunburns, hashish/marijuana use and multiple sexual partners). Social work students displayed better behaviours in physical activity and breakfast intake. CONCLUSION: Nursing students share the patterns of their nonnursing peers in behavioural risk factors compromising their future health and health-promoting role. We need strategies to safeguard the professional nursing practice.

Assessment of Unmet Supportive Care Needs in Haematological Cancer Survivors

Background: Health needs assessment is crucial for the provision of individualized nursing care. However, many patients report a significant number of unmet needs. The aim of the present study was the assessment of self-reported unmet supportive care needs among haematological cancer survivors in Greece. Methods: 102 patients (mean age 66.2 years old) diagnosed with haematological cancer were included in a cross-sectional study, conducted in two major Greek public hospitals, between October and December 2016. Patients' needs were assessed using the 'Needs Evaluation Questionnaire' (NEQ). Data analysis was conducted using the Statistical Package for Social Sciences software for Windows. Alfa-level (p-value) selected was 5%, bootstrap techniques were used for 95% CI estimation, χ2 was used for differentiation control and Kuder-Richardson coefficient for reliability score assessment (ρ = 0.922). Results: Patients reported higher needs levels "to receive less commiseration from other people" (48%), "more information about my future condition" (44.1%) and "to feel more useful within my family" (42.2%). In contrast, patients reported lower levels to the needs "to speak with a spiritual advisor" (11.8%), "to have more help with eating, dressing and going to the bathroom" (13.7%) and "better attention from nurses" (18.6%). The mean score of satisfied patients (≥8/10) was 8.9 (SD 1.7). Associations between socio-demographic, hospitalization data and unmet needs groups were identified. The less satisfied patients (<8/10) reported more informational needs about their diagnosis and their future condition (p-value=0.002), about their exams and treatments (p-value=0.001), communicative (p-value <0.001), assistance and treatment (p-value<0.001) and hospital infrastructure (p-value <0.001). Conclusion: Various factors seem to be associated to the prevalent unmet care needs among haematological cancer patients. Establishing NEQ as a routine needs assessment tool could aid health professionals to early identify patients' needs in a busy clinical setting and implement more individualized and patient-centered quality care.

The relationship between smoking and convivial, intimate and negative coping alcohol consumption in young adults.

AIMS AND OBJECTIVES: To explore the gender-specific associations of smoking with convivial, negative coping and intimate drinking contexts in young adults. BACKGROUND: Alcohol and cigarettes co-use is common and to be more effective in prevention activities, we need to understand the drinking contexts that facilitate their co-occurrence. DESIGN: Descriptive cross-sectional survey in the context of the LATO study (Lifestyle & Attitudes in a Student Population) in Greece. METHODS: Of the 1,138 students who provided full data during November-December 2012, those who have smoked ≥1 cigarette/last month were defined as smokers. Based on the "Drinking Context Scale-9", we created low, moderate and high probabilities of drinking in each context and in total. Multivariate logistic regression analyses were performed. RESULTS: Participants reported higher probabilities to drink, in descending order, in the convivial (31.5%), negative coping (10.4%) and intimate (5.4%) contexts. Adjusted odds ratios for smoking were significantly higher for individuals who reported a moderate (OR = 2.15, 95% CI 1.51-3.05) to high (OR = 3.64, 95% CI 2.59-5.11) probability of drinking in any context. Moreover, female participants with high probabilities for drinking in convivial and negative coping contexts had higher odds ratios of engaging in smoking (convivial OR = 1.87, 95% CI = 1.23-2.85; coping OR = 2.66, 95% CI = 1.39-5.10) whereas this association was noticed only for convivial settings in male participants (OR = 2.88, 95% CI = 1.91-4.319). For women only, drinking in intimate contexts was protective against smoking (OR = 0.32, 95% CI = 0.10-0.98). CONCLUSIONS: Smoking is differentially related to drinking context based on gender. Prevention interventions targeting smoking and alcohol co-use in late adolescence may be more effective if employing a context and gender-specific approach. RELEVANCE TO CLINICAL PRACTICE: Nurses have a critical role in providing motivational interviewing in individuals and organise and execute health-promoting activities in larger groups for modifying their health risk behaviours. The social context should be carefully considered during assessments and prevention interventions.

Attitudes towards people with physical or intellectual disabilities among nursing, social work and medical students.

AIMS AND OBJECTIVES: To examine and compare undergraduate healthcare students' attitudes towards people with physical or intellectual disabilities in Greece. BACKGROUND: The experience that people with disabilities have with health care is a complex interaction between their medical condition and the social and physical environment. Attitudes of the nursing and healthcare staff affect the quality of care and people's adaptation to their disability, self-image and rehabilitation outcomes. DESIGN: Descriptive cross-sectional survey. METHODS: Nursing, Social Work and Medicine students (N = 1007, 79.4% female) attending three universities (Athens, Crete) completed during 2014-2016 two standardised scales regarding physical (ATDP-B) and intellectual disability (CLAS-ID). Descriptive and multivariate logistic regression analyses were performed. RESULTS: Attitudes towards people with physical disabilities in Greece (ATDP-B scores) were poor with scores just above the mid-point. Medical studies and higher knowledge and work with individuals with physical disabilities signified marginally more positive attitudes. Gender and age displayed no associations with attitudes. Regarding intellectual disability (CLAS-ID scores), nursing students had slightly less positive attitudes in "Similarity" but more positive attitudes in "Sheltering" subscales. Previous work and contact was related to more favourable and higher age to less favourable "Similarity" and "Sheltering" attitudes. Males had higher "Exclusion" scores. Those who knew people with intellectual disabilities had less favourable "Empowerment" attitudes. Knowledge was related to more positive attitudes in all four CLAS-ID subscales. CONCLUSIONS: Greek health and social care students showed poor attitudes towards people with physical and intellectual disability. RELEVANCE TO CLINICAL PRACTICE: When holding unfavourable attitudes, healthcare professionals become less involved with the people they care for and they do not provide nursing care to the best of their abilities. Undergraduate and continuing education, along with workplace enhancements, should aim to provide high-quality health care to people with disabilities.

Associations of Bullying and Cyberbullying With Substance Use and Sexual Risk Taking in Young Adults.

PURPOSE: This study aims at identifying the sex-stratified associations of involvement in traditional bullying during middle and high school years and in cyberbullying during college years with multiple health risk behaviors in undergraduate students. DESIGN: This cross-sectional analysis draws on the data of the second wave of the LATO study (Lifestyle & Attitudes in a Student Population) in Greece. METHODS: During November and December 2013, 812 second-year undergraduate students (mean age = 19.3 years; girls = 66.1%) provided data on substance use (smoking, alcohol abuse or drunkenness, illegal drug use including marijuana, hashish, and cannabis) and sexual risk taking (paying for sex and not using condoms) and completed the Cyberbullying and its Effects and the Retrospective Bullying Questionnaires. Logistic regression models performed were adjusted for potential confounders. FINDINGS: Both male and female late adolescents who were victims of bullying during middle and high school were less likely to use condoms during college years when compared to uninvolved students. Among males, being a bully or victim at school doubled the odds for past month drunkenness and tripled the odds of paying for sex. Greater likelihood to pay for sex was also evident in bullying victims. Cyberbully or cybervictim male students were more likely to report smoking. In female bullying victims, alcohol abuse associations were somewhat conflicting, with decreased lifetime but increased past month likelihood for drunkenness. CONCLUSIONS: Engagement in bullying and cyberbullying is associated with the manifestation of gender-specific health risk behaviors for the different involvement groups in college students. CLINICAL RELEVANCE: Involvement in bullying and cyberbullying is a major public health concern due to the associations with multiple health risk behaviors. Nurses and healthcare professionals should adopt multifaceted prevention interventions tailored according to bullying status and gender that extend through all educational levels.

Social Capital, Perceived Economic Affluence, and Smoking During Adolescence: A Cross-Sectional Study.

BACKGROUND: Smoking is among the health risk behaviors taken up by many adolescents with lifelong consequences and associations with multiple health risk behaviors. Smoking and smoking initiation in adolescence involves an interaction between micro-, meso-, and macro systems, including neighborhoods and the greater community. OBJECTIVES: To examine the associations of individual social and economic capital with self-reported health, life satisfaction, and smoking behavior in adolescents. METHODS: Using a multistage random sampling of junior high school students (16-18 years old) in Crete, Greece, 703 adolescents (90.2% 16 years old; 55.6% girls, participation rate 84.2%) completed an anonymous questionnaire based on HBSC study and the Youth Social Capital Scale (YSCS) during April-June 2008. Multiple logistic regression models were performed adjusted for potential confounders. RESULTS: Adolescents with high participation in their neighborhoods and communities (higher structural social capital) displayed lower odds for daily smoking; those feeling unsafe (lower cognitive social capital) were at greater odds of daily smoking. Adolescents with less friends and acquaintances had lower odds of having tried tobacco products. Smoking was not related to any economic capital variables (perceived affluence, paternal and maternal employment status). Adolescents with low/medium versus high total social capital were at higher odds for low life satisfaction and fair/bad versus excellent self-rated health. Conclusions/Importance: Social capital theory may provide a better understanding in identifying the social context that is protective or harmful to adolescents' smoking. Public health organizations at all levels need to incorporate social capital theory in their interventions.

Gender differences in the prevalence and clustering of multiple health risk behaviours in young adults.

AIMS: To estimate the sex-stratified prevalence and clustering of 14 behavioural and metabolic health risk factors in emerging adulthood. BACKGROUND: The high prevalence and the clustering of risk factors multiply health consequences and increase the threat to the future health and quality of life of young adults. DESIGN: Descriptive cross-sectional study. METHODS: During November-December 2012, we assessed 14 lifestyle characteristics of 1058 1st year university students' that were classified as: healthy (score = 0), unhealthy (score = 1) and high-risk unhealthy (score = 2). We subsequently created a Multiple Health Risk Behaviours Index by summing the score of each behaviour adjusted to 0-100. RESULTS: Only 0·3% of the students had one risk behaviour and 21·3% (male: 31·5%; female: 12·6%) had ≥10 of 14. Male students had higher risk index score. In adjusted regression analyses, female students had higher odds of reporting healthier behaviours in oral hygiene (tooth brushing), red meat and junk food consumption, binge drinking, cannabis/hashish/marijuana use and lower number of sexual partners and Body Mass Index. Male students reported higher physical activity. No statistically significant gender differences were noted for screen time/sedentary behaviours, condom use, smoking, sunburns, breakfast and fruit and vegetable consumption. CONCLUSION: Although health-compromising behaviours are highly prevalent in both men and women, they are gender-related, with males engaging in more health risk behaviours than females. Preventive interventions may need to focus on gender-informed approaches when targeting multiple health risk behaviours.

Social capital, tolerance of diversity and adherence to Mediterranean diet: the Rhea Mother-Child Cohort in Crete, Greece.

OBJECTIVE: To estimate the associations of individual maternal social capital and social capital dimensions (Participation in the Community, Feelings of Safety, Value of Life and Social Agency, Tolerance of Diversity) with adherence to the Mediterranean diet during pregnancy. DESIGN: This is a cross-sectional analysis of data from a prospective mother-child cohort (Rhea Study). Participants completed a social capital questionnaire and an FFQ in mid-pregnancy. Mediterranean diet adherence was evaluated through an a priori score ranging from 0 to 8 (minimal-maximal adherence). Maternal social capital scores were categorized into three groups: the upper 10 % was the high social capital group, the middle 80 % was the medium and the lowest 10 % was the low social capital group. Multivariable log-binomial and linear regression models adjusted for confounders were performed. SETTING: Heraklion, Crete, Greece. SUBJECTS: A total of 377 women with singleton pregnancies. RESULTS: High maternal Total Social Capital was associated with an increase of almost 1 point in Mediterranean diet score (highest v. lowest group: ß coefficient=0·95, 95 % CI 0·23, 1·68), after adjustment for confounders. Similar dose-response effects were noted for the scale Tolerance of Diversity (highest v. lowest group: adjusted ß coefficient=1·08, 95 % CI 0·39, 1·77). CONCLUSIONS: Individual social capital and tolerance of diversity are associated with adherence to the Mediterranean diet in pregnancy. Women with higher social capital may exhibit a higher sense of obligation to themselves and to others that may lead to proactive nutrition-related activities. Less tolerant women may not provide the opportunity to new healthier, but unfamiliar, nutritional recommendations to become part of their regular diet.

Social capital and adherence to cervical and breast cancer screening guidelines: a cross-sectional study in rural Crete.

Breast and cervical cancers are among the leading causes of female mortality. The reasons that make women adhere, or not, to screening guidelines are not only related to individual and health characteristics but are also placed in a wider social and cultural context. Social capital might facilitate the dissemination of relevant knowledge of and the adherence to cancer screening guidelines. This cross-sectional study explored the associations of individual-level social capital with breast and cervical cancer screening and the knowledge for the existence of relevant screening tests (Pap test and mammography) in the municipality of Gorgolaini, a rural area in Crete, Greece. A random sample of 131 of the 592 women of the 2001 electoral register were invited to participate in the study and 125 completed the Social Capital Questionnaire and two questions on self-reported health knowledge and behaviour (participation rate 95.4%). Women were eligible to participate if they were aged 35-75, had lived in the area for the last 10 years and were of Greek origin. Multiple logistic regressions were performed to establish associations among each social capital factor (total, participation in the community, value of life, tolerance for diversity, feelings of safety, family/friends connections) and knowledge of and adherence to breast and cervical cancer screening guidelines after adjustment for confounders. Our results suggest that early detection of breast and cervical cancers may be facilitated when taking into account the social context of the population.

Social capital in pregnancy and postpartum depressive symptoms: a prospective mother-child cohort study (the Rhea study).

BACKGROUND: Depression, and to a lesser extent postpartum depressive symptoms, have been associated with characteristics of the social environment and social capital. Up to the present, mostly cross-sectional studies have explored such an association without providing a clear temporal relationship between social capital and depression. OBJECTIVES: To estimate prospectively the effect of individual-level self-reported maternal social capital during pregnancy on postpartum depressive symptoms. DESIGN: Prospective mother-child cohort (Rhea study). SETTINGS: 4 prenatal clinics in Heraklion, Crete, Greece. PARTICIPANTS: All women for one year beginning in February 2007. From the 1388 participants, complete data were available for 356 women. METHODS: Women self-completed two questionnaires: The Social Capital Questionnaire at about the 24th week of gestation and the Edinburgh Postnatal Depression Scale (range 0-30) at about the 8-10th week postpartum. Maternal social capital scores were categorized into three groups: the upper 10% was the high social capital group, the middle 80% was the medium and the lowest 10% was the low social capital group that served as the reference category. Multivariable log-binomial and linear regression models were performed for: the whole available sample; for participants with a history of depression and/or prenatal EPDS≥13; for participants without any previous or current depression and prenatal EPDS score<13. Potential confounders included demographic, socio-economic, lifestyle and pregnancy characteristics that have an established or potential association with maternal social capital in pregnancy or postpartum depressive symptoms or both. RESULTS: Higher maternal social capital was associated with lower EPDS scores (highest vs lowest group: ß-coefficient=-3.95, 95% CI -7.75, -0.14). Similar effects were noted for the subscale value of life/social agency (highest vs lowest group: ß-coefficient=-5.96, 95% CI -9.52, -2.37). This association remained significant for women with and without past and/or present depression only for the subscale value of life/social agency although with a more imprecise estimate. No effect was found for participation, a structural dimension of social capital. CONCLUSIONS: Women with higher individual-level social capital in mid-pregnancy reported less depressive symptoms 6-8 weeks postpartum. Given the proposed association of perceptions of the social environment with postpartum depressive symptoms, health professionals should consider evidence-based interventions to address depression in a social framework.

Maternal social capital and birth outcomes in the mother-child cohort in Crete, Greece (Rhea study).

This cohort study aimed to estimate the effect of individual maternal social capital during pregnancy on birth outcomes in the context of the Mother-child cohort (Rhea study), in Crete-Greece. Women were recruited from four prenatal clinics in Heraklion-Crete for one year beginning in February 2007. 610 women completed the self-administered Social Capital Questionnaire at about the 24th week of gestation. The scale assessed total maternal social capital and four social capital subscales: Participation in the Community, Feelings of Safety, Value of Life and Social Agency, and Tolerance of Diversity. Potential confounders included characteristics that have an established or potential association with the maternal social capital, and the birth outcomes (preterm birth, small weight for the gestational age, fetal weight growth restriction, weight, length and head circumference). The results of logistic and linear regression models indicated that there was an increase in the risk of preterm birth for every unit increase in maternal participation (range 12-48), and especially in the risk of medically indicated preterm birth. Although the findings suggest that participation is associated with an increased probability for preterm birth, we cannot know whether this is a protective or damaging social capital effect. Women who participate more in their communities may have enhanced access to information and/or resources, easier access to health care and support when they face maternal and fetal conditions that trigger the need for medical intervention. On the other hand, women may be more exposed to social and/or environmental stressors. Future research needs to distinguish between different types of participation and different components of social capital to better understand their associations with birth outcomes.

Development of the Social Capital Questionnaire in Greece.

The Greek version of the social capital questionnaire (SCQ-G) was evaluated in a sample of 521 adults drawn from three different urban areas in Greece. Exploratory factor analysis followed by multi-trait scaling yielded six factors: Participation in the Community, Feelings of Safety, Family/Friends Connections, Value of Life and Social Agency, Tolerance of Diversity, and Work Connections. The factor solution is similar to the patterns identified originally in Australia and the US. Variations suggest that social capital does not share the same structure in different countries. The SCQ-G is a useful scale to measure individual-level social capital in Greece. Social capital measurement tools should be validated in each cultural or national setting in which they are used.