Learning a Healthy Rhythm: An Intervention to Increase Children's Resources for Stress Management.

This article describes a pilot test of a community engaged, culturally relevant, arts-based intervention. The purpose was to increase children's personal protective buffering resources. Protective buffering resources help children cope with stressful stimuli, reduce activation of their systemic stress response, mitigate allostatic load, and promote optimal health. The "Learning a Healthy Rhythm" intervention included a stress management component and an ongoing Afro-Latino percussion program for 18 children ages 9-11. The stress management component included educational content about stress, self-assessment of stress symptoms, and stress management techniques. A mixed-method intervention evaluation design was used. Qualitative data, quantitative data, and biometrics including hair cortisol were collected. Six intervention parameters were evaluated: effectiveness, fidelity, feasibility, acceptability, necessity, and safety. Positive results were obtained for all parameters. Reduction in physiological and subjective measures of stress was evident. This stress management intervention was well-received and supported by participants.

Culture and sexuality-related communication as sociocultural precursors of HPV vaccination among mother-daughter dyads of Mexican descent.

U.S. Latinas are the second most affected ethnic group by cervical cancer morbidity and mortality. Cervical cancer is caused by high risk Human Papillomavirus (HPV) strains and HPV vaccines are an effective form of primary prevention. Parents are the primary decision makers of vaccination uptake as vaccination is recommended for children between the ages of 11-12. The purpose of our study is to investigate the influence of sociocultural factors particularly salient to U.S. Latinos and their role in facilitating or hindering communication about sexuality and vaccination uptake. We conducted a mixed methods sequential study with Latina mother-daughter dyads of Mexican descent (50% who had vaccinated). Our study was informed by the Information-Motivation-Behavioral Skills (IMB) model of preventive behavior. We assessed the influence of communication about sexuality on uptake and the influence of relationship factors such as familism, mother-daughter connectedness, and children's autonomy and cultural factors such as acculturation and ethnic identity on sexuality-related communication. Our results indicated that mothers who engaged in conversations about birth control methods with their daughters had 5.69 times the odds of having vaccinated their daughters. Our qualitative data indicated that mothers who had vaccinated communicated about sexuality emphasizing that sexuality is a normal part of life, perceived that their child is likely to be sexually active one day, and viewed themselves as a primary source of sexuality-related information compared to mothers who had not vaccinated. Findings highlighted potential sociocultural approaches to motivate open communication about sexuality and adoption of sexual health preventative measures for children.

Trauma-related symptoms and severity among women in the Pacific Rim.

Current understandings of the effects trauma exposure on women's health are limited because prior research has largely focused on intimate partner and sexual violence in homogenous samples. In this descriptive study, the authors examined the relationships between lifetime trauma exposure and psychological well-being among women across the Pacific Rim. Psychological well-being differed significantly between the four locations and increased trauma exposures were related to poorer psychological well-being across and within locations. The authors report relevant findings on the relationship between trauma exposure and psychological well-being and provide evidence for future research to enhance knowledge on the effects of trauma in women's lives.

The Influence of Masculinity on Male Latino Adolescents' Perceptions Regarding Dating Relationships and Dating Violence.

In the United States, teen dating violence (TDV) is a concern across ethnic groups. Attitudes and correlates of violence differ by gender, culture, and acculturation. This study used a qualitative interpretive approach. Data were obtained in focus groups with 23 Latino male adolescents. Themes reflected contexts of participants' lives, and definitions and nature of dating relationships and TDV. Participants described the importance of respecting dating partners, the destructive effects of TDV, and the pressure to display masculinity that can lead some young men to perpetrate TDV. These results may advance culturally relevant interventions to promote healthy relationships and prevent dating violence.

Trauma Exposure Among Women in the Pacific Rim.

PURPOSE: Healthcare professionals who provide services in the immediate or long-term aftermath of traumatic events need to understand the nature and frequency of traumatic events in the lives of women. However, research on trauma exposure in women has only recently begun to assess events other than intimate partner and sexual violence and has not supported direct statistical comparison of cross-national and cross-cultural data. The purpose of this descriptive, correlational study was to describe and compare trauma exposure prevalence and type in community-based samples of women in the United States, Colombia, and Hong Kong. DESIGN: Women were recruited through posted notices at community health sites, snowball sampling, and online advertisements (N = 576). The Life Stressor Checklist-Revised (total score range 0 to 30) was used to determine the type and prevalence of trauma exposure. Data were collected by native language members of the research team. METHODS: Descriptive statistics were used to summarize demographic characteristics and trauma exposure for the total sample and each community-based sample (location). Between-location differences were tested using Fisher's exact tests for categorical measures and general linear models with pairwise a posteriori least squares t-test for continuous measures. Responses to open-ended questions were translated and categorized. FINDINGS: Over 99% of women in the total sample reported at least one traumatic life event. The mean number of traumatic life events per participant was 7, ranging from 0 to 24. Although there was consistency in the most commonly reported trauma exposures across locations, the rates of specific events often differed. CONCLUSIONS: Historical, political, geographic, and cultural factors may explain differences in trauma exposure among women in the four locations studied. CLINICAL RELEVANCE: This study offers relevant knowledge for providers in diverse locations who provide services to women who have experienced traumatic events and provides evidence for the need for future research to further enhance knowledge of trauma exposure among women, and on the effects of trauma in women's lives.

Desert, detention, and deportation: Mexican women's descriptions of migration stressors and sources of strength.

I analyzed interviews (n = 10) of women recently deported from the United States of America to Mexico, exploring what women experienced immediately after deportation. The women who were residing in a short-term shelter in Nogales, Mexico, described their greatest stressors and sources of strength. Women identified the border crossing experience, apprehension, detention, and family separation due to deportation as stressors. Sources of strength included God and family. Irregular migration is not unique between the United States and Mexico. Women migrate in search of work, education, and safety. I offer these women's stories as exemplars and this study as one to be replicated with women in other contexts across the globe.

Spirituality and Religiosity in Adolescents Living With Sickle Cell Disease.

This study purports to address paucity in the literature regarding how adolescents with sickle cell disease (SCD) describe and experience spirituality and religiosity (S/R). This was a qualitative descriptive study. Two semi-structured interviews were conducted with nine adolescents (Mage = 16.2 years). Data were analyzed using a template analysis style and a concurrent analysis process of data reduction. Three major themes encompassed the participants' descriptions of the relationships between S/R, health and illness in their lives including S/R as sources for coping, influence of S/R beliefs on health and illness, and sharing S/R with Health Care Providers (HCPs). S/R as coping mechanisms included six threads: interconnecting with God, interconnecting with others, interconnecting with creative arts, scriptural metanarratives, transcendent experiences, and acceptance and finding meaning. Expectations of health providers included two threads: Religiosity is private/personal and sharing spiritual and religious beliefs is risky. S/R are particularly salient for adolescents with SCD.

Self-Care Behaviors of African Americans Living with Heart Failure.

African Americans have a higher risk of developing heart failure (HF) than persons from other ethnic groups. Once diagnosed, they have lower rates of HF self-care and poorer health outcomes. Promoting engagement in HF self-care is amenable to change and represents an important way to improve the health of African Americans with HF. This study used a community-based participatory action research methodology called photovoice to explore the practice of HF self-care among low-income, urban, community dwelling African Americans. Using the photovoice methodology, themes emerged regarding self-care management and self-care maintenance.

Factors influencing self-care behaviors of African Americans with heart failure: a photovoice project.

OBJECTIVES: The purpose of this study was to understand the influences of heart failure (HF) self-care among low income, African Americans. BACKGROUND: Compared to all other racial groups, African Americans have the highest risk of developing HF, coupled with high mortality and morbidity rates. METHODS: Using the photovoice method, participants related important lifestyle factors through photography. The participants and researcher met for reflection and discussion 2 h per week for six weeks. RESULTS: Four themes emerged: family support gives me the push I need, social interaction lifts me up, improving my mind to lift depression can improve my heart, and it is important but challenging to follow the HF diet. CONCLUSION: The findings from this study may assist policy makers, health care professionals, patients, and support systems in understanding the complexity of engaging in HF self-care. This understanding may lead to the development of appropriate patient-centered assessments and interventions.

A theater intervention to prevent teen dating violence for Mexican-American middle school students.

PURPOSE: To test a theater intervention designed to raise awareness of the dynamics and consequences of teen dating violence (TDV) and to facilitate creation of nonviolent responses to TDV among Latino and Latina adolescents. The intervention was based on Theater of the Oppressed, which advocates the use of theater methods to explore social issues and to allow audiences to experiment with problem-solving, thereby promoting change. METHODS: This study used a pretest-posttest, no control group, mixed-measures design to study 66 Mexican-American adolescents (mean age, 13.4 ± 5 years). Two plays containing subtle and overt signs of control and abuse were written and performed. Scripts were based on data from prior studies of TDV among Latino and Latina adolescents. At baseline, we measured sociodemographics, personal safety, and ethnic identity. Pre-post instruments measured acceptance of TDV, confidence to resolve conflicts nonviolently, and intentions to use nonviolent strategies to resolve conflict. We collected qualitative data via essay. RESULTS: At posttest, participants had less acceptance of TDV (t = -2.08; p < .05), increased confidence to resolve conflicts nonviolently (t = 3.82; p < .001), and higher intentions to use nonviolent strategies (t = 3.35; p = .001). We analyzed 20 essays. Qualitative results provided context for understanding participants' changes in attitude, confidence, and nonviolent behavioral intentions. CONCLUSIONS: This adaptation of Theater of the Oppressed was an effective way to interact with Latino adolescents. In a safe setting, participants vicariously experienced TDV, which facilitated self-reflection and cognitive rehearsal strategies to respond nonviolently to TDV.

Integrative review: parent perspectives on care of their child at the end of life.

This integrative review aims to describe parents' perspectives on end-of-life care for their children. Fifteen publications from a literature search of the Cochrane databases, CINAHL, MEDLINE, and PSYCHinfo were included in the review. Recurring themes included poor communication/lack of information, strained relationships/inadequate emotional support, parental need to maintain parent/child relationships in life and death, quality of care continues after the death of the child, influence of services/planning on parent/child impacts quality of life, and the difficult decision to terminate life support. No studies were identified that focused on parents' perspectives on the care their child received at the end of life. Further research that focuses on the special needs of parents at this difficult time is needed.

Mexican American female adolescents' perceptions of relationships and dating violence.

PURPOSE: This study fills a gap regarding the perspectives of Mexican American female adolescents on dating relationships and dating violence (DV). METHODS: This was a qualitative descriptive study. Focus groups included 20 Mexican American young women, primarily first and second generation, mean age 14.5 years (SD= 2.5). Data were analyzed with categorical analysis. FINDINGS: Participants described key components of DV and identified cultural aspects that may serve to promote healthy dating relationships. CONCLUSIONS: Family-based interventions to promote exploration of gender roles and parent-child communication may foster biculturalism as well as promote healthy dating relationships and prevent violence within this cultural group. CLINICAL RELEVANCE: In the United States, 10% to 40% of teens experience DV. Hispanic females experience more physical DV than their White peers.

Short of transformation: American ADN students' thoughts, feelings, and experiences of studying abroad in a low-income country.

ADN students are a large yet distinct subgroup of nursing students who require research and understanding. The purpose of this study was to describe the thoughts, feelings, and experiences of American associate degree nursing (ADN) students who participated in a short study abroad course in a low-income country. A qualitative, narrative method was used. Three categories emerged from the analysis. Participants revealed thoughts of "constant comparisons", feelings of an "emotional journey", and they experienced "learning". Participants did not demonstrate perspective transformation as defined by Mezirow as participants signified no intent for social action. Several potential blocks to perspective transformation were identified: egocentrism/emotional disconnect, perceived powerlessness/being overwhelmed, and a vacation mindset. The findings provide insight into the student experience of studying abroad. Transformative learning is not a guaranteed result. Nurse educators must consider strategies to foster transformation including discussing global systemic oppressors, international relations, coping, connecting, and social action.

Transformative learning through study abroad in low-income countries.

Study abroad in low-income countries is an emerging trend in nursing education, yet student outcomes vary from positive to negative. Study abroad in low-income countries can be transformative because it has the potential to increase student awareness of socioeconomic relations, structural oppression, and human connectedness. The authors discuss 10 strategies to facilitate transformative learning in students who study abroad.

Translation and adaptation of the life stressor checklist-revised with Colombian women.

We undertook the translation and adaptation of an instrument developed to measure women's lifetime trauma exposure, the Life Stressor Checklist-Revised (LSC-R), in order to determine its utility and cultural appropriateness with Colombian Spanish-speaking women. The LSC-R was forward and backward translated and administered to a sample (N = 217) of community-based women volunteers in Medellín, Colombia. Open-ended questions were included to assess the construct validity and cultural appropriateness of the LSC-R. The LSC-R was found to be valid and easily understood. Trauma exposure was common, but its assessment was not overly distressing to Colombian women.

As time goes by we improve a little more: relationship expectations of young women in Mexico.

In this qualitative narrative study I explore expectations regarding male-female relationships and perceptions about intimate partner violence (IPV) with young urban women in the state of Veracruz, Mexico. Carol Gilligan's work informed the analysis of the narratives. Themes identified follow: violence at home, resistance, and relational autonomy. The collective story these women tell is that they are familiar with violence in the home, they resist violence and gender inequality, they seek equality in intimate partner relationships, and they plan for futures where the centrality of family is valued in combination with a strong commitment to their own autonomy.

The relationship of two types of trauma exposure to current physical and psychological symptom distress in a community sample of Colombian women: why interpersonal violence deserves more attention.

Our purpose in this study was to examine the relationship between interpersonal violence and background traumas and symptom distress in a community sample of Colombian women (N = 217). We utilized the Life Stressor Checklist-Revised (LSC-R) to measure lifetime interpersonal violence (IPV) and background trauma exposure and the Brief Symptom Inventory (BSI) to measure current symptom distress. Although both exposures were common in this sample, IPV was strongly correlated with current symptom distress; background traumas made no unique contribution to the variance in current symptom distress. Based on our findings, it is suggested that interpersonal events may be particularly distressing.

Listening sessions with Latinas: documenting life contexts and creating connections.

OBJECTIVE: To use listening sessions with groups of Latinas to develop a contextual understanding of the lives of immigrant women to inform program development and ultimately better serve the community's needs for domestic violence services. DESIGN AND SAMPLE: This study was exploratory and descriptive, mixing qualitative listening sessions with quantitative methods. Seven listening group sessions were facilitated with 63 women participating. MEASURES: Data included information from a short demographic questionnaire, texts of narrative from the sessions, and tallies of thematic comments made during the listening sessions. RESULTS: Themes derived from aggregated data from the listening sessions included women's Unmet Needs, Responsibilities, Goals, Achievements, Help-seeking, and Intimate Partner Violence (IPV). Findings indicated that Latinas' comments were often family-focused and they have many unmet needs. Familiarity with community resources to meet needs was not consistent across groups, for example, women who had not utilized domestic violence services were unlikely to know where to obtain help for IPV problems. CONCLUSIONS: The ease with which women shared knowledge of resources and offered emotional support to each other during listening sessions supports their use by bilingual public health nurses in communities for needs assessment, education, and networking among Latinas.

Teaching social justice using a pedagogy of engagement.

Teaching an undergraduate level diversity course with a health focus requires specific teaching methods. A pedagogy of engagement provides an effective strategy for exploring issues of race, class, gender, and structural inequalities that underlie health disparities. Engagement learning enhances understanding of theories of oppression and liberation presented in the course and highlights social justice issues.

When I was in my home I suffered a lot: Mexican women's descriptions of abuse in family of origin.

In this descriptive study we employ episodic narrative interviews and narrative analysis to explore experiences of abuse and violence within the families of origin of Mexican women entering adulthood. Twenty-four Mexican women, 18 years of age and about to graduate from a residential school in central Mexico, were interviewed about life in their families of origin. Participants were from several Mexican states and of low socioeconomic status. Nineteen of the participants described either witnessing or experiencing violence or abuse within their families. We present an analysis of the interviews in which violence or abuse was disclosed. Women who witnessed violence against their mothers did not see this as prescriptive of their own future relationships and articulated strategies for avoiding entering an abusive relationship. Women who experienced nonsexual physical violence described physical violence as punishment. Women who experienced sexual abuse did not provide explanations for the abuse and described being silent in response to the abuse.