"Speak from a place of love": The family dynamics surrounding Black father-daughter sexual health communication.

INTRODUCTION: Parent-child sexual health communication reduces sexual risk behaviors among youth, which in turn lowers the transmission rate of HIV and sexually transmitted infections. Despite being a known protective factor, gender differences persist with mothers being more likely to discuss sexual health with their children than fathers. Although individual characteristics, interpersonal familial factors and societal norms (e.g., communication self-efficacy, parent-child closeness, and cultural and gender norms) are associated with Black parents' likelihood to communicate about sex with their children, the current study seeks to explore which of these factors found among Black mother-child or father-son dyads extend to Black father-daughter dyads and how this phenomenon (i.e., Black father-daughter sexual health communication) relates to family structure. METHODS: Seven father-daughter dyads (N = 7) and an additional five daughters (n = 5) in the United States completed individual in-depth semi-structured interviews. Daughters (Mage = 20.3) and fathers (Mage = 56.7) were biologically related, majority heterosexual, close, and lived together. Data were transcribed verbatim and analyzed using thematic analysis. RESULTS: Analysis revealed three themes centering around the role of authoritative parenting, the tactics and skills facilitating sexual health communication, and family structure. CONCLUSIONS: Black father-daughter sexual health communication is facilitated by close father-daughter relationships, non-authoritative parenting styles, and open, supportive, and non-judgmental communication. Fathers can be better supported in knowing how and when best to communicate sexual health messages, and to mitigate the possibly negative impacts on communication of divorce or having multiple children.

Resilient Infant Feeding Among Young Women With Histories of Maltreatment and Poor Support.

OBJECTIVE: To explore how young women with histories of maltreatment describe their experiences and decisions around infant feeding. DESIGN: Secondary qualitative analysis using supplementary analysis. SETTING: Washington, DC; Baltimore, MD; and their respective suburbs. PARTICIPANTS: Young women with histories of being abused or neglected as children or adolescents and who gave birth to one child before age 19 years (N = 9). METHODS: We collected data through in-depth semistructured interviews and analyzed them using reflexive thematic analysis. RESULTS: The analysis resulted in three themes: Infant Feeding Intention, Identifying Challenges and Persistence, and Pivoting to What Is Feasible. Participants felt that breastfeeding was valuable and wanted to be able to breastfeed their children. They continued to provide human milk through painful latches and a lack of support and guidance, but formula became the only viable option for many of them. CONCLUSION: Despite wanting to breastfeed and continuing through barriers, many participants could not continue to breastfeed as long as they wanted because of a systemic lack of support. These findings indicate a need to support young women with histories of maltreatment through increased and consistent access to lactation support providers and trauma-informed care. Nurses and other clinicians are uniquely positioned to support young women with histories of maltreatment to overcome barriers related to breastfeeding.

"I Need to Get My Culture Back": Youth and Provider Perspectives on Integrating Culturally Based Approaches into Sexual and Reproductive Health Programs for Native Hawaiian and Pacific Islander Youth Experiencing Homelessness.

There is growing interest in decolonizing sexual and reproductive health (SRH) and embedding cultural practices into social and medical services in Hawai'i. Wahine ("woman") Talk is a multilevel, comprehensive SRH program for female youth experiencing homelessness (YEH) led by community health, social work, and medical providers. This study examines youth and program provider perspectives of culturally based approaches that may strengthen SRH programs. The study team conducted three focus groups and ten in-depth interviews with participating youth and program providers after the program's conclusion. Youth participants were aged 14 to 22 years (M = 18.1) and of Native Hawaiian or Pacific Islander ancestry. Interview transcripts were analyzed using structured thematic analysis. The youth described feeling estranged from their ancestral cultures and suggested incorporating multiple cultural practices to enhance their connection to community, body, and land into SRH programming for YEH. They identified several 'aina ("land")-based approaches, hands-on learning, hula, and language as possible practices to weave into the program. While youth felt estranged from their ancestral cultures, they discussed Native Hawaiian and Pacific Islander health perspectives where 'aina and relationships are considered life-sustaining. Youth and program staff stressed incorporating culture respectfully, caring for the whole person, and providing trauma-informed care. Future policy, practice, and research should consider protecting and integrating Native Hawaiian conceptions of health into SRH policy and practice and include youths' cultural identities in SRH intervention development.

Sexual health communication among Black father-daughter dyads: A grounded theory study.

Black young adults have disproportionately high rates of HIV and sexually transmitted infections (STIs) when compared with the national average. Although parent-child sexual health communication among Black families has been shown to reduce sexual risk-taking behaviors, far less is known about father-daughter sexual health communication when compared with communication among gender-congruent dyads and mothers. This dearth of knowledge hinders the development of sexual health interventions involving fathers that are sensitive to both the gendered and cultural context. Using constructivist-grounded theory, the present study explores the context surrounding sexual health communication between Black women aged 19-21 (M = 20.3) years and their biological fathers aged 52-60 (M = 56.7) years. Seven father-daughter (N = 7) dyads and an additional five (N = 5) daughters completed individual in-depth semistructured interviews lasting on average 84 min in length. Analysis revealed several social, cultural, and familial contexts impacting father-daughter communication, in addition to factors that either motivate or hinder communication. Daughters who did not engage in sexual health communication with their fathers expressed an interest in doing so, and participants highlighted varying behavioral, emotional, and relational outcomes resulting from father-daughter sexual health communication or the lack thereof. Study findings can inform future intervention development and strengthen the positive role fathers play in ensuring daughters' healthy sexual development. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Achieving Safe, Effective, and Compassionate Quarantine or Isolation of Older Adults With Dementia in Nursing Homes.

Nursing homes are facing the rapid spread of COVID-19 among residents and staff and are at the centre of the public health emergency due to the COVID-19 pandemic. As policy changes and interventions designed to support nursing homes are put into place, there are barriers to implementing a fundamental, highly effective element of infection control, namely the isolation of suspected or confirmed cases. Many nursing home residents have dementia, associated with impairments in memory, language, insight, and judgment that impact their ability to understand and appreciate the necessity of isolation and to voluntarily comply with isolation procedures. While there is a clear ethical and legal basis for the involuntary confinement of people with dementia, the potential for unintended harm with these interventions is high, and there is little guidance for nursing homes on how to isolate safely, while maintaining the human dignity and personhood of the individual with dementia. In this commentary, we discuss strategies for effective, safe, and compassionate isolation care planning, and present a case vignette of a person with dementia who is placed in quarantine on a dementia unit.

Changing Pattern of Sedative Use in Older Adults: A Population-Based Cohort Study.

BACKGROUND: Benzodiazepine medications have well-documented side effects, and their prescription rates in older adults have been declining. Trazodone and quetiapine are medications with sedative properties when used at low doses and are commonly used off-label for sleep or behavioral symptoms in older adults. OBJECTIVE: Our objective was to describe the shifting patterns of sedative prescription in older adults over time by comparing changes in benzodiazepine, trazodone, and quetiapine dispensing between community and long-term care settings. METHODS: We conducted a population-based serial cross-sectional study to compare the patterns of sedative dispensing (specifically, benzodiazepines, trazodone, and quetiapine) to individuals aged ≥66 years between 1 January 2002 and 31 March 2013 in Ontario, Canada. We compared rates of use between long-term care and community settings and used linear regression models to characterize the magnitude and direction of the rate of change in sedative use by age, sex, and dementia status. RESULTS: The dispensing of trazodone and quetiapine increased over time, and this coincided with a decrease in benzodiazepine dispensing. This pattern was particularly apparent in the oldest cohort and in those with dementia. Benzodiazepines, trazodone, and quetiapine were associated with high rates of psychotropic polypharmacy. Overall trends were similar in long-term care and the community. CONCLUSIONS: While benzodiazepine prescribing is declining among older adults in Ontario over time, there is a corresponding shift towards low-dose, off-label prescribing of trazodone and quetiapine and psychotropic polypharmacy. These prescribing trends highlight sedative substitution and reinforce the need to confirm efficacy and safety of this practice.

The comparative effects of environmental enrichment with exercise and serotonin transporter blockade on serotonergic neurons in the dorsal raphe nucleus.

We have previously reported that inhibition of the serotonin transporter (SERT) by selective serotonin reuptake inhibitor (SSRI) fluoxetine significantly reduces the number of tryptophan hydroxylase (TPH)-positive cells in the dorsal raphe nucleus (DRN). We have been interested in exploring whether this SSRI-induced change in TPH might be modified by housing in an enriched environment. Like SSRI antidepressants, environmental enrichment (EE) and physical exercise have been found to have efficacy in the prevention and alleviation of depression. We postulated that EE with exercise and SERT inhibition would similarly affect TPH regulation and that EE with exercise might modify the effect of fluoxetine on TPH. Three week old male Sprague-Dawley rats were housed in either a standard cage (SE) or an enriched environment (EE). SE animals were singly housed with no access to enrichment objects. EE animals were group housed and were provided with various enrichment objects (e.g. running wheel) that were changed and rearranged regularly. Nine weeks after the experiment began, the rats were randomly assigned to one of four treatment groups: (1) SE control; (2) SE fluoxetine; (3) EE control; or (4) EE fluoxetine. Fluoxetine (5 mg/kg/day) was placed in the drinking water. Sections of DRN were processed for TPH immunohistochemistry. The number of TPH-positive cells was determined by blinded, manual counting. Results were analyzed by analysis of variance (ANOVA) followed by post-hoc Tukey tests. Significance was set at P < 0.05. For animals housed in a standard environment, fluoxetine induced a significant 29% reduction in the number of TPH-immunoreactive cells in the DRN. A similar reduction in TPH immunoreactivity was observed in animals that were housed in an enriched environment but not exposed to fluoxetine (39%). The number of TPH-positive cells in the DRN for animals housed in an enriched environment and exposed to fluoxetine was not significantly different than animals housed in an enriched environment and not exposed to fluoxetine. The reduction of TPH immunoreactivity in the DRN by EE with exercise suggests that a modified housing environment and voluntary exercise affects regulation of TPH, possibly via a mechanism similar to that of SERT inhibitors. This downregulation of serotonin biosynthesis by fluoxetine and EE with exercise may ultimately play a role in the therapeutic action of both interventions.