Impact of COIL: Learning From Student Nurses in Norway Who Collaborated With U.S. Students.

AIM: The aim of this study was to describe the experience of Norwegian nursing students with internationalization through participation in a Collaborative Online International Learning (COIL) course. BACKGROUND: Educators in Norway and the United States collaborated to incorporate internationalization and population health concepts into virtual courses during the pandemic. Literature gaps exist in post-implementation assessment data that ascertain internationalization through the COIL experience. DESIGN: This was a qualitative study with a descriptive design. Data were collected from focus group interviews and analyzed conventional content-analysis approaches. METHODS: Fifteen Norwegian undergraduate nursing students who participated in the COIL opportunity completed focus group interviews. FINDINGS: The themes identified included, "virtual conversation builds collaborations and enhances learning," and "this opened my eyes." CONCLUSIONS: Norwegian students acknowledged they had learned transferable lessons from their global partners that could be applied to patient care of the marginalized population in Norway.

Reflections from Refugee Adolescent Girls on Participation in a US-Based Teen Sexual Health Promotion Project.

Refugee girls may be unprepared for the sexual risk challenges facing teens in the US. We sought to understand refugee girls' general experience, discussions with parents and motivations related to participation in an evidence-based sexual risk reduction program. Through semi-structured interviews with twelve girls ages 15-17 years from nine countries, we acquired insight into the girls' reactions to the program, if they had discussed their experiences, and reflections on their decision to participate. Qualitative analysis of verbatim transcriptions identified three themes: (1) my cultural norm is not to ask; (2) groups were a safe way for me to learn and share; and (3) I learned to use my voice. As the numbers of adolescent refugees grow, we cannot ignore their need for tailored sexual health research and programming. This first-of-its-kind study provides insight into acceptability, motivation for participation, and impact of a sexual health promotion program.

Nausea, Vomiting, and Nonbloody Diarrhea in the Emergency Department.

Nausea, vomiting and diarrhea are frequent co-occurring symptoms that can mask or mimic commonly occurring conditions, or rarely, more serious concerns. The Ending the HIV Epidemic's focus on increased widespread use of PrEP, a biomedical HIV prevention strategy, highlights the importance of discussing common clinical management scenarios. The use of oral PrEP formulations has demonstrated a "startup syndrome" which involves GI upset. This case challenge of a 32year old client admitted to the ED with GI symptoms highlights key PrEP considerations including a sexual health history. Clinicians should understand common complaints associated with oral PrEP start to improve differential diagnosis and appropriate intervention.

Virtual Study-Abroad Through Web Conferencing: Sharing Knowledge and Building Cultural Appreciation in Nursing Education and Practice.

BACKGROUND: With a focus on building global citizens, a U.S. and Norwegian academic collaborative partnership fostered clinical learning experiences addressing cultural and health care comparisons. High-impact educational practices integrated into international clinical experiences, combined with virtual global learning classrooms, highlighted the Sustainable Development Goals. PROBLEM: Given nursing education's requirements, devising innovative strategies expanded global learning in brief but transformative experiences while integrating nontraveling students, especially relevant considering current pandemic-related travel restrictions. APPROACH: We developed an educational experience pairing U.S. students (17 in person; 64 through web conference) and Norwegian students (50 in person; 3 for web conference) in population health experiences, providing required clinical hours and a shared cultural exchange. Integration of nontraveling students in joint virtual global experiences broadened the global learning opportunity for all. CONCLUSION: This work offers insight into how faculty used a virtual global learning experience as a synergistic tool with traditional study abroad.

Perceptions Toward Mental Illness and Seeking Psychological Help among Bhutanese Refugees Resettled in the U.S.

This study examined perceptions toward mental health and seeking psychological care among Bhutanese refugees in a large Midwestern U.S. city. Bhutanese adults (n = 201) completed a community health needs assessment. Survey questions addressed beliefs toward mental health and seeking psychological care. Perceptions toward mental illness and receiving psychological help were generally negative among participants. Over 71% believed others would look unfavorably on a person who sought out a counselor. Participants who had less than a high school education, were 35 years and older, and lived in refugee camps for more than 20 years had significantly greater negative beliefs toward mental illness. Over one-third (34.8%) of participants reported access to counseling services as being somewhat of a problem or a serious problem. These findings may inform future research and interventions aimed at improving mental health among Bhutanese refugees.

Adolescents in Scotland: Challenges and Opportunities for Sexual Risk Reduction.

Sexually transmitted infections, HIV, and unplanned pregnancy challenge the health of Scottish teens. We conducted focus groups with teens (ages 16-19 years) recruited from an urban youth cafe in Edinburgh and assessed sexual risk-taking and protective behaviors. A trained facilitator, using a semi-structured interview guide, led the groups. We taped and transcribed data verbatim for coding and theming. The teens revealed similar concerns despite differences in gender and/or sexual histories. Despite school-based sex education, sex was rarely discussed with peers or adults outside classrooms; the ability to practice communication and negotiation skills was minimal. Much risky behavior occurred in public spaces and was often linked to drug or alcohol intake. There was a glaring lack of teen planning for, or contemplating, future adult lives. Findings highlight the challenges these teens faced in practicing safer sex and limited opportunities to tailor intervention strategies to address the cultural realities of their lives.

Making a Case for Integrating Evidence-Based Sexual Risk Reduction and Mental Health Interventions for Adolescent Girls.

Recently identified as the top concern of teens, mental health issues now compete with sexual health risks as major threats to the well-being of adolescent females. Depression and anxiety can lead to or compound the negative repercussions of sexual behavior choices that result in disproportionately high rates of sexually-transmitted infections (STIs), hetero-sexually acquired HIV, and unplanned pregnancy rates in girls ages 15-19. There are a limited number of CDC- and DHHS-recognized HIV/STI and teen pregnancy evidence-based interventions (EBIs) targeted to adolescent girls of diverse races/ethnicities and none that simultaneously address common mental health disorders. The Health Improvement Project for Teens (HIPTeens), a manualized gender-specific sexual risk reduction intervention, and the Creating Opportunities for Personal Empowerment (COPE) Program, a manualized cognitive-behavioral skills intervention that reduces depression and anxiety, are recognized by national agencies as strong EBIs that have successfully improved their targeted outcomes. Baseline data from the HIPTeens clinical trial revealed that a substantial portion of the more than 700 girls enrolled had moderate to high levels of depressive symptoms as well as other mental health challenges (e.g., binge drinking and eating, cannabis use). Thus, there is an urgent need to combine EBIs, such as HIPTeens and COPE, to curtail these leading public health problems confronting today's adolescents.

The HIP LADIES: A Pilot Health Improvement Project for HIV Prevention in Black College Women.

A disproportionate number of new HIV infections in the United States occur in Black women. We pilot-tested feasibility and acceptability of a manualized HIV prevention intervention developed with and for Black college women. We used a prospective, randomized 2-group design, with 3 data collection times. Participants included 18- to 24-year-old Black women (N = 65), who were enrolled at 2 southern universities; 46 completed pre- and post-assessments. We found that participants in the intervention arm had positive changes in HIV knowledge (p < .0001) and behavioral intentions (p = .039) outcomes. There were, however, no significant differences between intervention and control groups when considering motivational factors and behavioral skills that promoted HIV prevention: social norms, condom use self-efficacy, and assertive sexual communication. We found preliminary evidence of efficacy for an HIV prevention intervention tailored to Black college women. Researchers should partner with Black college women to develop and implement HIV prevention interventions.

Adolescent Girls' Experiences With Sexual Pressure, Coercion, and Victimization: #MeToo.

BACKGROUND: The #MeToo social media campaign in the United States has highlighted what is a pervasive problem in many cultures-the sexual intimidation and victimization of women by men, especially those in roles of authority. METHODS: In a study of 735 girls, ages 15-19 years, enrolled in a sexual risk reduction randomized controlled trial, we captured baseline data using audio-computer assisted self-interviews to increase validity and reliability of responses to questions regarding such behaviors. RESULTS: Despite their age, one-half of these girls reported being coerced into sex acts (excluding intercourse) with 1 in 5 reporting such victimization by a man who used his position of authority. Alarmingly, 12-28% of girls reported being forced into penetrative sex acts against their will. Far too many girls reported they had had multiple episodes of such violence. LINKING EVIDENCE TO ACTION: It is clear that this study captures a common, but minimally documented, threat faced by adolescent girls ranging from men pressuring them to engage in sex activities through the use of victimization, intimidation, or provision of substances to underage girls to gain compliance. Using such evidence to enhance and tailor sexual risk reduction, health, safety, and communication interventions for both males and females is essential. Identifying triggers to at-risk situations, providing skill building in communication, negotiation and refusal skills, as well as clearly discussing consent issues among both genders are important components in evidence-based interventions if we are to impact positively the next generation to curtail sexual pressure, coercion, and violence.

Understanding the "Why" for High-Risk Behavior: Adolescent Girls' Motivations for Sex.

Identifying why girls participate in safe and risky sexual behaviors is key to developing successful intervention strategies. This study identified motivations for sex in 738 girls enrolled in the Health Improvement Project for Teens (HIPTeens) randomized controlled trial and analyzed differences in sex motives among at-risk subgroups. Sexually active girls, ages 15-19 years, were recruited from urban community-based settings. Baseline data were collected via audio computer-assisted self-interview surveys including a modified Sex Motives Scale based on six domains (intimacy, enhancement, self-affirmation, coping, peer pressure, and partner approval), assessing drivers of both protective and risk-promoting motivations. Statistically significant motive differences across domains were identified among subgroups with different risk profiles, including mental health issues (depression, drug and alcohol use) as well as demographic group characteristics (race, age, and parental status). Understanding why girls have sex provides an opportunity to address motivation-focused strategies that may augment intervention efficacy.