Nativity/language, neighborhoods, and teen pregnancy norms among U.S. Hispanics.

This study examined the relations of nativity, language, and neighborhood context to pregnancy norms among U.S. Hispanic teens. We used data from a sample of 972 Hispanic females and 960 Hispanic males from Waves I and II (1994-1996) of the National Longitudinal Study of Adolescent to Adult Health (Add Health) collected in eighty high schools and fifty-two middle schools across the country. Results indicated that nativity, language, and neighborhood context were related to Hispanic teen pregnancy norms, although these relationships varied by gender. Specifically, foreign-born, non-English speaking females and those who lived in immigrant neighborhoods held stronger norms against unmarried teen pregnancies compared to English speakers and/or lived elsewhere. Yet, no relationship was demonstrated for males. The results of this study suggest an immigrant advantage related to female teen pregnancy norms, and that context matters in the formation of pregnancy norms for Hispanic females.

Burnout among direct-care workers in nursing homes: Influences of organisational, workplace, interpersonal and personal characteristics.

AIMS AND OBJECTIVES: The many negative effects of burnout have prompted researchers to better understand the factors contributing to it. The purpose of this paper is to add to this body of knowledge through the study of burnout among direct-care workers in nursing homes. BACKGROUND: Perhaps the factor most often associated with employee burnout is the level of staffing-insufficient staffing results in work overload and eventually employee burnout. A closer look at research findings suggests that there are many other factors also contributing to burnout. These range from those at the organisational level, such as availability of training and resources to individual characteristics such as self-esteem and length of employment. METHODS: A self-administered survey instrument was completed by 410 direct-care workers working within 11 nursing homes in the north Texas region. Regression analyses were performed, adjusting for clustering by nursing home. Beta coefficients and structure coefficients are reported. Burnout was measured through three dimensions: emotional exhaustion, depersonalisation and personal accomplishment. RESULTS: Organisational, work design, interpersonal and individual characteristics were found to be associated with one or more dimensions of burnout. CONCLUSIONS: The analyses largely support previous research. Organisational variables of significance included the availability of resources to do the work, available training and fair pay. Work design variables of significance included adequate staffing. The individual characteristic, self-esteem, appeared to have the strongest impact on burnout. Commitment to the organisation also had a large impact. RELEVANCE TO CLINICAL PRACTICE: While the data do not allow for the testing of causal relationships, the data do suggest that providing adequate staffing, perceived fair pay, sufficient work resources (e.g., towels, gowns), management support and adequate training may result in less direct-care worker burnout on the job.

Community Influences on Married Women's Safer Sex Negotiation Attitudes in Bangladesh: A Multilevel Analysis.

The influence of disadvantaged or deprived community on individuals' health risk-behaviors is increasingly being documented in a growing body of literature. However, little is known about the effects of community characteristics on women's sexual attitudes and behaviors. To examine community effects on married women's safer sex negotiation attitudes, we analyzed cross-sectional data from the 2011 Bangladesh Demographic and Health Surveys on a sample of 15,134 married women in 600 communities. We estimated two multilevel logistic regression models. Model 1, which included only individual-level variables, showed that women's autonomy/empowerment, age, and HIV knowledge had significant associations with their safer sex negotiation attitudes. We did not find any socioeconomic status gradient in safer sex negotiation attitudes at the individual level. Adding community-level variables in Model 2 significantly improved the fit of the model. Strikingly, we found that higher community-level poverty was associated with greater positive safer sex negotiation attitudes. Prevailing gender norms and overall women's empowerment in the community also had significant effects. While research on community influences calls for focusing on disadvantaged communities, our research highlights the importance of not underestimating the challenges that married women in economically privileged communities may face in negotiating safer sex. To have sufficient and equitable impact on married women's sexual and reproductive health, sexual and reproductive health promotion policies and programs need to be directed to women in wealthier communities as well.

Environment and subjective well-being of rural Chinese elderly: a multilevel analysis.

INTRODUCTION: The purpose of this study was to examine the effects of environment on the subjective well-being (SWB) of older Chinese villagers after controlling for personal and social characteristics. METHOD: Data collected from the Chinese Health and Retirement Longitudinal Survey Pilot Study were used to examine the relationship between (a) SWB (i.e., happiness and depressive symptoms) of Chinese rural elderly and (b) environmental characteristics, controlling for personal and social characteristics. A total of 850 older villagers from 2 Chinese provinces were analyzed using multilevel regression models. RESULTS: Five of the 8 environmental variables had significant effects on SWB: A natural disaster in the past 5 years, rainy days, and use of coal in the home were associated with lower SWB, whereas village wealth and sewer system were associated with higher SWB. Personal and social characteristics of importance included health, age, place of birth, perception that future help is available if needed, and providing help to others. DISCUSSION: The proposition that the environment of older Chinese villagers is associated with their SWB was supported after accounting for personal and social characteristics. SWB may be improved by improving environments as well as by changes to personal and social conditions.

Can a woman refuse sex if her husband has a sexually transmitted infection? Attitudes toward safer-sex negotiation among married women in Bangladesh.

In developing countries, HIV, sexually transmitted infections (STIs) and unintended pregnancy take an enormous toll on women's reproductive health, yet preventive programmes are lacking as married women's risks are frequently underestimated. We examined predictors of married Bangladeshi women's attitudes towards safer-sex negotiation using data on 15,178 currently married women aged 15-49 from the 2011 Bangladesh Demographic Health Survey. Approximately 92% of women believed that a wife's refusal to have sex with her husband is justified if he has an STI. Multilevel logistic regression analysis revealed that the likelihood of a woman holding this belief increased with her autonomy, as measured by the ability to go to a health centre/hospital without another adult, participation in household decision making and rejection of wife beating (p < 0.001). Other significant predictors were knowledge/awareness of STIs (p < 0.05), living in Dhaka division (p < 0.001) and younger age (p < 0.01). Our findings suggest that sexual health education programmes may be more effective if they include strategies to address social norms and cultural practices that limit women's autonomy in society.

Social capital and self-rated health among middle-aged and older adults in China: a multilevel analysis.

This study examined the association between social capital, at both the individual and the community level, and self-rated health among older adults in China. Using data from the 2008 Pilot Survey of China Health and Retirement Longitudinal Study, a series of multilevel logistic models were estimated in SAS 9.2. The association between social capital and self-rated health was examined among 996 adults aged 45 or older from two provinces in China, while controlling for demographic characteristics and socioeconomic variables. Our results suggest the significant association between certain aspects of social capital, at both the individual and the community level, and self-rated health. The individual-level social capital in the form of perceived help in the future and the social capital of community in the form of the availability of amenities and associations within the community were significantly related to self-rated health. A significant cross-level interaction effect between individual- and community-level social capital was also observed.

Village characteristics and health of rural Chinese older adults: examining the CHARLS Pilot Study of a rich and poor province.

Community (or village) characteristics have received growing attention as researchers have sought factors affecting health. This study examines the association between a variety of environmental, economic, and social village characteristics and health of Chinese older rural adults with health measured in terms of physical limitations. The Chinese Health and Retirement Longitudinal Survey (CHARLS) Pilot Study data were used. Older villagers from a low-income province (Gansu) and a relatively wealthy province (Zhejiang) were surveyed between July and September, 2008. The sample included 1267 respondents in 73 villages age 45 and older. The relationship between a variety of village characteristics and physical limitations of older adults was examined using negative binomial regression (NBR) with standard errors adjusted to account for non-independence of respondents in a village. A comparison of means/percentages shows that Gansu and Zhejiang were significantly different on the dependent and most independent variables. The NBR models show that at the personal-level, decreased risk of physical limitations was associated with being male, less than 60 years old, married, higher in education, and higher in household expenditures (proxy for income). At the village-level, decreased risk of limitations was associated with a continuous supply of electricity, not using coal in the household, the existence of a sewage system, low cost of electricity, and village wealth. Decreased risk of physical limitations was also associated with various characteristics of China's New Cooperative Medical Scheme (NCMS), an insurance program for rural older adults. Policy implications for improved health of rural older adults include: (1) continued use of China's NCMS, (2) establishment of village sewage systems, (3) ending the use of coal in the home, and (4) increased educational opportunities focused on health.

Nurse aide decision making in nursing homes: factors affecting empowerment.

AIMS AND OBJECTIVES: To evaluate factors affecting structural empowerment among nurse aides in nursing homes. BACKGROUND: Structural empowerment can be defined as the actual rather than perceived ability to make autonomous decisions within an organisation. Given the paucity of research on the subject, this study helps to close the gap by identifying factors that affect nurse aide empowerment, that is, decision-making among nurse aides. METHODS: The data for the study come from self-administered questionnaires distributed to direct-care workers (nurse aides) in 11 nursing homes in a southern state in the USA. Ordinary least square regression models were estimated to analyse the effects of demographic predictors, personal factors (competency, emotional exhaustion and positive attitude) and structural characteristics (coworker and supervisor support, information availability and shared governance) on nurse aide decision-making. RESULTS: Findings suggest race among demographic predictors, emotional exhaustion among personal characteristics, and supervisor support, and shared governance among structural factors, significantly affect nurse aide decision-making. CONCLUSION: It is important to explore race as one of the central determinants of structural empowerment among nurse aides. In addition, the nature and type of emotional exhaustion that propels decision-making needs to be further examined. RELEVANCE TO CLINICAL PRACTICE: The study shows the importance of shared governance and supervisor support for fostering nurse aide empowerment.

The perception of "training availability" among certified nurse aides: relationship to CNA performance, turnover, attitudes, burnout, and empowerment.

The purpose of this study was to examine the relationship between the certified nurse aides' (CNAs) perception that "training is always available when needed" and the CNAs' performance, turnover, attitudes, burnout, and empowerment. The data came from a larger study where a self-administered survey instrument was completed by 359 CNAs working in 11 nursing homes in the North Texas region. The data analyses largely support previous research. Perceived training availability was most highly associated with participation in decision making, information exchange, the procedures used, and satisfaction/commitment. The data suggest that the CNAs surveyed may not have received substantial training related to the depersonalization of residents, self-esteem, and direct decision making. Further, the findings suggest an opportunity to improve training by including a component to help CNAs transfer the skills and knowledge learned during the training to the actual provision of resident care.

CNA empowerment: effects on job performance and work attitudes.

In this analysis, the effects of empowerment were examined among a sample of certified nursing assistants (CNAs) representing a wide range of empowerment levels. On the basis of survey responses from 298 CNAs and 136 nurses in five nursing homes where CNA-empowered work teams had been implemented and five nursing homes with more traditional management approaches, the results indicated that CNA empowerment had a variety of effects. CNAs with high empowerment and the nurses who worked with them tended to report better CNA performance and work-related attitudes. Both were also less likely to be thinking about leaving their jobs. With the help of lessons learned from new culture change initiatives, and with commitment, effort, and attention, nursing homes and other health care providers can reap the benefits associated with employee empowerment strategies, such as CNA-empowered work teams.

Consequences of empowered CNA teams in nursing home settings: a longitudinal assessment.

PURPOSE: Recent studies have concluded that there is a lack of "patient-centered" care in nursing homes and subsequently a need for nursing home culture change. As a result, a variety of new, promising initiatives have been introduced, with most of these incorporating the use of "empowered" employees. The purpose of this study was to evaluate the effects of empowered work teams--a work design specifically established to empower certified nurse aides (CNAs)--within the long-term-care setting. DESIGN AND METHODS: We used a multimethod, pretest-post-test design to examine the effects of these teams. Our qualitative analysis included observations of over 270 team meetings. The quantitative analyses included five pairs of nursing homes, with five implementing empowered work teams and five acting as comparisons. RESULTS: The quantitative as well as qualitative analyses indicate that the work teams had a variety of modest, positive effects: increased CNA empowerment; better CNA performance; improved resident care and choices; improved procedures, coordination, and cooperation between CNAs and nurses; and possibly reduced turnover. There appeared to be mixed effects on work attitudes. IMPLICATIONS: As new initiatives strive to move away from the medical model and toward a person-centered model, the data suggest that empowered CNA work teams can help.

Race and ethnic disparities in cervical cancer screening in a safety-net system.

OBJECTIVES: The three objectives of this research were: 1) to examine the use of Pap smear tests among low-income women, including minority and immigrant women who were patients in a safety-net healthcare system; 2) to identify policy relevant variables that could lead to changes in use of Pap smear screening services for these women; and 3) to contribute to the literature on use of Pap smear screening, especially among minorities and immigrants. The Behavioral Model for Vulnerable Populations was used as the theoretical framework. METHODS: Pap smear screening predictors were examined using telephone interviews with a random sample of women aged 18-60, including 465 Non-Hispanic Whites, 285 African Americans, 164 Hispanic Americans, and 256 Hispanic immigrants, enrolled in a safety-net healthcare system in Texas in Fall 2000. Binary logistic regression analysis was used. RESULTS: The research revealed that Non-Hispanic Whites were most likely to have been screened ever and in the past 3 years, followed by African Americans, Hispanic immigrants, and Hispanic Americans. Among Hispanics, immigrants were most likely to have had Pap smear screening, supporting the "healthy immigrant hypothesis." Older women were most likely to have ever been screened, with younger women, most likely in the past year. Having a usual source of healthcare and a checkup for current pregnancy increased screening, while competing needs (food, clothing, housing) affected screening negatively. CONCLUSIONS: Culturally competent, community-based care for women is needed to increase Pap smear screening among minority groups, especially Hispanic immigrant and Hispanic American women.

Self-managed work teams in nursing homes: implementing and empowering nurse aide teams.

PURPOSE: This article describes the progress of our study to examine the advantages and costs of using self-managed nurse aide teams in nursing homes, steps that are being taken to implement such teams, and management strategies being used to manage the teams. DESIGN AND METHODS: A quasi-experimental design is underway where certified nurse aide (CNA) teams are being established in five nursing homes (NHs) in the Dallas-Fort Worth metropolitan area, and five additional NHs are being treated as comparison NHs. RESULTS: As of March 2004 CNA teams were established in five NHs, and baseline survey data were collected from the CNAs, nurses, residents, and family members in each of these NHs as well as from those in the five comparison homes. IMPLICATIONS: Qualitative analyses show positive effects of CNA teams. Quantitative analyses will not be complete until follow-up survey data are collected 12 months after team implementation. Steps for implementing teams include surveying management to be sure that they want nurse teams; orienting and training the managers, nurses, and nurse aides; and facilitating the teams. Management of the teams includes routine feedback from management to the teams and vice versa while using a give-and-take approach.