A Pilot Study of a Teen Dating Violence Prevention Program With Karen Refugees.

While teen dating violence (TDV) prevention programs generally report changes in participants' attitudes and mixed findings about changes in behavior, little is known about the impact of TDV programs on ethnic minority youth. This study examined the effectiveness of Safe Dates, an evidence-based TDV prevention program, in educating 21 resettled Karen refugee youth from Burma. Findings indicated changes in attitudes toward violence occurred from pretest to follow-up. Years living in the United States was significantly related to pretest and posttest attitudes. More research about TDV is needed among Karen youth with attention given to the role of acculturation on TDV attitudes.

Implementation of a collaborative care model for the treatment of depression and anxiety in a community health center: results from a qualitative case study.

BACKGROUND: The collaborative care model is a systematic approach to the treatment of depression and anxiety in primary care settings that involves the integration of care managers and consultant psychiatrists, with primary care physician oversight, to more proactively manage mental disorders as chronic diseases, rather than treating acute symptoms. While collaborative care has been shown to be more effective than usual primary care in improving depression outcomes in a number of studies, less is known about the factors that support the translation of this evidence-based intervention to real-world program implementation. The purpose of this case study was to examine the implementation of a collaborative care model in a community based primary care clinic that primarily serves a low-income, uninsured Latino population, in order to better understand the interdisciplinary relationships and the specific elements that might facilitate broader implementation. METHODS: An embedded single-case study design was chosen in order to thoroughly examine the components of one of several programs within a single organization. The main unit of analysis was semi-structured interviews that were conducted with seven clinical and administrative staff members. A grounded theory approach was used to analyze the interviews. Line-by-line initial coding resulted in over 150 initial codes, which were clustered together to rebuild the data into preliminary categories and then divided into four final categories, or main themes. RESULTS: FOUR UNIQUE THEMES ABOUT HOW THE IMPLEMENTATION OF A COLLABORATIVE CARE MODEL WORKED IN THIS SETTING EMERGED FROM THE INTERVIEWS: organizational change, communication, processes and outcomes of the program, and barriers to implementation. Each main theme had a number of subthemes that provided a detailed description of the implementation process and how it was unique in this setting. CONCLUSION: The results indicated that adequate training and preparation, acceptance and support from key personnel, communication barriers, tools for systematic follow-up and measurement, and organizational stability can significantly impact successful implementation. Further research is necessary to understand how organizational challenges may affect outcomes for patients.

What leads non-U.S.-Born Latinos to access mental health care?

Latinos underutilize mental health care services. Of those who do, about 70% do not return after the initial visit. This study's purposes were: (1) to identify factors that led non-U.S.-born Latinos to utilize services from a nonprofit clinic in Texas and (2) to assess whether acculturation played a role in accessing mental health care. Data were collected over a 10-week period using an interview schedule and the Bidimensional Acculturation Scale for Latinos. Results indicate acculturation does not play a significant role in access, but patient knowledge of mental health care issues does. Specifically, the main barriers to access were: (1) lack of knowledge that there was a mental health issue; and (2) lack of knowledge of where to go for mental health services.

Using drama to prevent teen smoking: development, implementation, and evaluation of crossroads in Hawai'i.

The use of drama as a preventive education measure has demonstrated success in various health promotion venues and offers promise in promoting positive youth attitudes and behavior change related to tobacco use. Especially important is a need to implement culturally relevant methods to reach youth. This article describes the development and implementation of a tobacco prevention drama for Asian and Pacific Islander youth. The resulting play, Crossroads, features a soap opera-style drama interspersed with humorous vignettes and multimedia effects and incorporates cultural cues, mannerisms, dress, and values consistent with Asian and Pacific Islander youth culture. Evaluation data indicate that the drama has an effect on audience knowledge, attitudes, and intended behavior, including a change in future intent to smoke cigarettes and the ability of audience members to develop connections with the characters in the play and apply concepts that are presented in the play to their own lives.

Introducing educational interventions for first year medical students in the area of cancer clinical trials: impact on attitudes and confidence.

BACKGROUND: This study tested the feasibility and efficacy of a multi-faceted educational intervention designed to increase medical students' confidence in discussing cancer clinical trials with patients. METHOD: First year students were provided with written resources, problem-based learning scenarios, and an optional practicum. RESULTS: Pre/Post results indicated significant increases in confidence levels; however, these results were tempered with declines in attitudes related to clinical trials. CONCLUSIONS: Integrating clinical trials education into existing medical school curriculum is both feasible and desirable. This intervention was successful in increasing students' confidence levels in discussing clinical trials with patients and deserves continued study.

Coping with prostate cancer in Asian-American, Native Hawaiian, and Caucasian families.

Prostate cancer is the most commonly diagnosed invasive cancer among men in the United States. In order to explore the coping experience of men and their families facing prostate cancer, a qualitative analysis of written responses to open-ended questions related to roles during the illness experience, closeness of relationships, and coping strategies was conducted with a sample of 100 Caucasian, Asian, and Native Hawaiian participants. Results indicate that family members and friends are essential to coping with the effects of the disease, and also that spouses, children, and friends fulfill unique and important roles in facing the illness experience.

Multi-ethnic adolescents' attitudes toward smoking: a focus group analysis.

PURPOSE: To explore young, multi-ethnic adolescents' attitudes and influences related to cigarette smoking for the purpose of developing and producing a youth-led, tobacco prevention drama. DESIGN: Focus groups and demographic surveys. SETTING: Island of Oahu, Hawaii. PARTICIPANTS: Fifty-four multi-ethnic youth, ranging in age from 10 to 14 years, participated. The study was promoted in schools with a large representation of Hawaiian, Filipino, and Pacific Islander students. METHODS: Each of five focus groups was audio-recorded, and an observer recorded extensive notes throughout the sessions. Content analysis consisted of coding focus group notes for recurrent themes and using the audio recording as confirmation. RESULTS: Just more than one quarter (n = 15) of the youth had tried smoking, and two-thirds (n = 35) currently lived with someone who smoked. Participants expressed the feeling of being surrounded by smoking influences at home, in their communities, and at school. Youth were negatively affected by family members' tobacco use, and they desired skills that could enable them to help family members stop using tobacco. CONCLUSION: Family influences may play an important role in youth attitudes toward tobacco use, especially given the cultural significance of extended family and of filial piety that are reflected in many traditional, Asian and Pacific Islander families. Interventions targeting youth in Asian and Pacific Islander communities should incorporate key cultural references to the extended family and to a respect for elders to establish relevance in the life experiences of young people in these population groups.

Coping With Breast Cancer at the Nexus of Religiosity and Hawaiian Culture: Perspectives of Native Hawaiian Survivors and Family Members.

This article describes research to develop a breast health intervention for women in Hawaiian churches. Native Hawaiian women are disproportionately burdened by breast disease and tend to be diagnosed at advanced stages when treatment options are more limited. Research suggests that cultural conflict may be a factor in Hawaiian women's underutilization of conventional health services. Phenomenological approaches guided data collection and analysis to explore the influence of religiosity and ethnocultural tradition in coping with breast cancer. The overarching theme was kakou (we or us), which emphasized ways of coping oriented to the family collective and focused on family well-being. Findings offer a portal for understanding the lived experience of survivors and families in Hawaiian churches. Considerations are suggested for those practitioners assisting clients from collectivist-oriented cultures.

Empowering natural clinical trial advocates: nurses and outreach workers.

Cancer clinical trials are essential to advancing the prevention and treatment of cancer, yet adult participation rates in clinical trials remain abysmal. Despite the essential contributions of clinical trials to science and medicine, adult participation in clinical trials remains exceedingly low, with only 2%-4% of all adult patients with cancer in the U.S. participating in clinical trials. Clinical trials accrual rates in Hawai'i follow this national trend of less than 3% of eligible patients participating in trials. Recognizing the need to increase awareness about clinical trials, the National Cancer Institute's Cancer Information Service-Pacific Region, through the Hawai'i Clinical Trials Education Coalition, has employed strategic dissemination plans to train and educate key target audiences, including registered nurses, nursing students, and community outreach workers about the availability of over 90 cancer clinical trials in Hawai'i. Previous research suggests that nurses often play a vital role in increasing a patient's understanding of clinical trials and may also act as a patient advocate in regards to participation in a clinical trial. A train-the-trainer model curriculum was developed using the Clinical Trials Education Series (CTES), a collection of multi-level resources designed by the National Cancer Institute, to educate various constituents about clinical trials. The training curriculum and workshop format is adapted based on both formal and informal needs assessments conducted with audiences prior to the planned training, yet key elements remain central to the training model. In addition, an interactive, internet-based case study was developed using local place names and cultural cues to allow training participants to engage in realistic and practical methods for locating and sharing information about clinical trials with patients and the public. This training model has been implemented in a variety of settings including three statewide nursing conferences, two college campuses, and a community-based workshop. Evaluation results consistently indicate statistically significant increases in participants' knowledge and awareness related to clinical trials, and a cadre of trained clinical trials advocates is developing. Health professional advocacy towards adult participation in clinical trials is gaining momentum, with plans to expand the training model throughout the Pacific region.