Urban American Indian Adolescent Girls: Framing Sexual Risk Behavior.

PURPOSE: The purpose of this study was to explore factors that influence urban adolescent American Indian (AI) girls' sexual risk behavior. DESIGN: A qualitative study was conducted with grounded theory methodology to reveal factors and processes that influence sexual risk behavior. METHOD: Talking circles, individual interviews, and event history calendars were used with 20 urban AI 15- to 19-year-old girls to explore influences on sexual risk behavior. RESULTS: The generated theory-framing sexual risk behavior-describes social and structural factors and processes that influenced the girls' sexual risk behavior. The theory extends Bronfenbrenner's ecological model by identifying microsystem, mesosystem, and macrosystem influences on sexual risk behavior. DISCUSSION: Urban AI girls reported similar social and structural influences on sexual risk behavior as urban adolescents from other racial and ethnic groups. However, differences were noted in the family structure, cultural heritage, and unique history of AIs. IMPLICATIONS: This theory can be used in culturally responsive practice with urban AI girls.

Testing the Efficacy of a Computer-Based Parent-Adolescent Sexual Communication Intervention for Latino Parents.

The efficacy of a computer-based intervention to increase parent-adolescent communication among Latino parents and adolescents was tested in a randomized controlled trial. Parents assigned to receive the 2-session intervention reported greater general communication, sexual communication, and comfort with communication at 3 month follow-up than did parents assigned to the wait-list control condition. Adolescents, whose parents received the intervention, reported higher sexual communication than did adolescents whose parents were in the wait-list control condition. Results provide support for the efficacy of brief parent interventions designed to maximize adolescent support systems. The acceptability of the computer-based format for an underserved population provides an important venue for the delivery and use of health information.

Pediatric nurse practitioners in the United States: current distribution and recent trends in training.

OBJECTIVE: To assess the current distribution and training patterns of pediatric nurse practitioners (PNPs). STUDY DESIGN: Secondary data analysis from the National Association of Pediatric Nurse Practitioners and the 2008 US Census Bureau were used to estimate the distribution of PNPs per 100,000 children. Data on nurse practitioner (NP) graduation and specialty education programs were obtained from the American Association of Colleges of Nursing. RESULTS: PNPs have the greatest concentration in the New England and mid-Atlantic regions and a narrow band of Midwestern states. States that allow PNPs to practice or prescribe independently do not consistently have a higher density of PNPs per child population. There has been a slight decrease in the proportion of programs that offer PNP training. In the last decade, the proportion of NP graduates pursuing family nurse practitioner education has increased, and the proportion pursuing PNP education has decreased. CONCLUSION: Workforce planning for the health care of children will require improved methods of assessment of the role of PNPs and the volume of care they provide. Increased use of PNPs in pediatrics will likely require greater effort at recruitment of NPs into the PNP specialty.

Mexican adolescents' alcohol use, family intimacy, and parent-adolescent communication.

Despite widespread adolescent alcohol use, research on individual and contextual factors among Mexican adolescents is limited. This study describes the relationship between adolescent risk/protective factors, parent-adolescent communication, and their effects on alcohol use of 14- to 17-year-old adolescents living in Mexico (N = 829; 458 girls, 371 boys). In this study, adolescents reported that 55% ever used alcohol, 24% used alcohol in the past 30 days, and 10% reported binge drinking. Adolescents with high family intimacy were less likely to report ever using alcohol and binge drinking. Regression analysis revealed that parent-adolescent communication mediated the effect of family intimacy on overall and binge drinking. Alcohol use prevention with Mexican adolescents should focus on family intimacy and parent-adolescent communication.

Development and testing of the Diabetes Self-management Instrument: a confirmatory analysis.

The purpose of this study was to develop and psychometrically test a new instrument for measuring self-management of adults with type 2 diabetes. Data were collected from 634 diabetic adults recruited from three teaching hospitals in Taiwan. Construct validity was determined by confirmatory factor analysis (CFA). Tests of internal consistency and test-retest were used to assess the reliability of the diabetes self-management instrument (DSMI). Initial results of CFA did not fully support the proposed five-factor model. After the model was modified, the fit indices indicated that this model fits the data best. This model was further cross validated in a second sample. Cronbach's alpha coefficient of the DSMI total scale was .94. The test-retest correlations for the DSMI total scale were acceptable (r = .73, p < .01).

Integrating evidence-based clinical and community strategies to improve health.

Multiple and diverse preventive strategies in clinical and community settings are necessary to improve health. This paper (1) introduces evidence-based recommendations from the U.S. Preventive Services Task Force sponsored by the Agency for Healthcare Research and Quality and the Community Task Force sponsored by the Centers for Disease Control and Prevention, (2) examines, using a social-ecologic model, the evidence-based strategies for use in clinical and community settings to address preventable health-related problems such as tobacco use and obesity, and (3) advocates for prioritization and integration of clinical and community preventive strategies in the planning of programs and policy development, calling for additional research to develop the strategies and systems needed to integrate them.

Alcohol, children, and adolescents.

Alcohol use in children and adolescents continues to be a major health concern. There is a rich literature on correlates and antecedents of alcohol use in children and adolescents, and concerted efforts have been made to develop, implement, and evaluate intervention strategies. This chapter provides a review of the intervention studies to prevent alcohol use in these groups. The interventions are categorized by their primary focus: school, family, and community. The studies were limited to those with either an experimental or a quasi-experimental design and published results.

Really underage drinkers: alcohol use among elementary students.

Despite the current societal concern with underage drinking, little attention has been paid to alcohol use within the preadolescent population. This article presents the proceedings of a symposium held at the 2003 Research Society on Alcoholism meeting in Fort Lauderdale, Florida, that was organized and chaired by John E. Donovan. The intent of the symposium was to kick start research on alcohol use among elementary school children by reviewing what is known regarding drinking in childhood. Presentations included (1) The Epidemiology of Children's Alcohol Use, by John E. Donovan; (2) The Validity of Children's Self-Reports of Alcohol Use, by Sharon L. Leech; (3) Predicting Onset of Drinking From Behavior at Three Years of Age: Influence of Early Child Expectancies and Parental Alcohol Involvement Upon Early First Use, by Robert A. Zucker; and (4) Parent, Peer, and Child Risk Factors for Alcohol Use in Two Cohorts of Elementary School Children, by Carol J. Loveland-Cherry. Presentations indicated the need for better nationwide surveillance of children's experience with alcohol; suggested that children's reports of their use of alcohol tend to be reliable and valid; supported children's alcohol use schemas and parental drinking and alcoholism at child age three as independent predictors of early onset drinking; and showed that onset of drinking before fourth or fifth grade, peer pressure, and parental norms and monitoring predict elementary student alcohol use and misuse.