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ABSTRACT: Homeless and runaway youth face a variety of health, risks, including those related to substance abuse and use of unsterile
needles. During 1998–1999, we recruited 201 Minneapolis homeless youths aged 15–22 years; these youths were interviewed by
experienced street outreach workers from settings where street youth were known to congregate. Respondents spent a median
of 6 months in the previous year living on the streets or “couch hopping.” There were 37% who reported having 15 or more alcoholic
drinks per week, 41% smoked 1 pack or more of cigarettes per day, and 37% used marijuana 3 or more times a week; 15% reported
lifetime injection drug use, including 6% who used injection drugs within the previous month. Twenty percent had received
a tattoo, and 18% body piercing with a needle that had not been sterilized or had been used by someone else. There were 68%
who had been tested for human immunodeficiency virus (HIV), 52% for hepatitis B, and 25% for hepatitis C. There were 44% who
said they did not have enough information about hepatitis B and C. Less than half (43%) received hepatitis B vaccine; however,
51% of unvaccinated youths indicated that they would receive vaccination if offered. These Midwestern homeless youths face
multiple health risks, including those related to substance use and exposure to unsterile needles. Despite unsafe behaviors,
many of these youths were interested in methods to protect their health, including education, knowing their HIV or viral hepatitis
serostatus, and obtaining hepatitis B immunization.
KeywordsAdolescence-Hepatitis B virus-Hepatitis C virus-Human immunodeficiency virus-Substance use
Journal of Urban Health 04/2012; 78(4):690-698. · 2.13 Impact Factor
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ABSTRACT: Many East African refugee women have experienced torture and trauma while fleeing from their home countries. Many also experience high rates of isolation, depression, and symptoms of posttraumatic stress disorder after resettlement. Effective methods are needed for improving the mental well-being of this population. This pilot study (N = 19) tested the feasibility, accessibility, and acceptability of a strengths-based, community-delivered intervention with Somali and Ethiopian women refugees. Feasibility was established through recruitment, retention, participation, and participant response. Accessibility was established through providing meals, transportation, and child-care assistance. Acceptability was established through evaluating translated materials, cultural congruence, and perceived relevance. Results support testing in a full-scale controlled study.
Journal of Loss and Trauma 09/2010; 15(5):408-425. · 1.03 Impact Factor
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ABSTRACT: Refugees have faced extraordinarily stressful situations in their past, and many continue to experience stress daily as they cope with the refugee adjustment experience. A strengths-based, community-focused intervention known as Health Realization (HR) is a promising strategy for nurses to promote positive psychological outcomes in these populations. Although similar in some ways to cognitive therapy, the HR intervention emphasizes the role of thought versus the content of thought. It does not promote actively changing intrusive or negative thoughts but rather promotes an understanding that allows a degree of detachment from thoughts--a shift in consciousness that can provide relief and facilitate healing. An adapted stress and coping model provides a theoretical framework to test the effectiveness of using HR with refugees, which in turn provides a solid foundation for research that can support or refute the existing substantial anecdotal evidence for the use of this intervention in holistic nursing practice.
Journal of Holistic Nursing 10/2007; 25(3):186-94.
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ABSTRACT: Interest in alternative/complementary therapies (A/CTs) is on the rise, yet little is known about adolescents' use of A/CTs. The study purpose was to examine A/CT utilization patterns among a clinic-based sample of adolescents.
A cross-sectional survey of 401 adolescents, aged 12-18 years, was conducted in one Midwest urban adolescent ambulatory clinic in 2002.
Overall, 68.1% of the adolescents reported using one or more A/CT; most commonly, herbal medicines (27.2%), massage therapy (26.7%), and megavitamins (21.7%). Use by friends and family was the primary influence for adolescent A/CT use; lack of familiarity was the greatest reason for nonuse (53.9%). Alleviation of physical pain (66.3%) was the most common desired health outcome. Few adolescents (13.8%) disclosed A/CT use to their health care providers. Insurance coverage was provided for 10.2% of the therapies and out-of-pocket costs averaged 67 dollars/month. Age, race/ethnicity, having a health condition, taking medications, health responsibility, and work status were associated with overall A/CT use in bivariate analyses. Of these, only associations between A/CT use and race/ethnicity and health responsibility remained statistically significant after adjusting for the other variables.
Use of A/CTs was common among these adolescents, yet very few disclosed their use to health care providers. Providers must ask about A/CT use to gain a more complete understanding of health practices among adolescents in clinical settings. Future research is needed to better understand representative patterns of A/CT use.
Journal of Adolescent Health 08/2005; 37(1):76. · 3.33 Impact Factor
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ABSTRACT: To describe war-related trauma history, immigration factors, problems, and coping of Somali and Oromo refugee youth.
Analysis of a subset of participants (N = 338) aged 18-25 years from a population-based survey of Somali and Oromo refugees conducted in 2000-2002. Data included trauma history, life situation, and scales for physical (Cronbach alpha =.69), psychological (alpha =.56), and social problems (alpha =.69). Data were analyzed using Chi-square and Mann-Whitney U tests.
Average emigration age was 14.8 years, with 4.2 years in transit and 2.0 years in the United States; 60% reported plans to return home to live. Two-thirds (66%) had less than a high school education, 49% had English language problems, 49% were employed (38% female vs. 57% male); 70% were single, with Somali females more likely than Oromo to be partnered and mothers (39% vs. 19%). There were significant ethnicity/gender differences for all problem scales. More females reported feeling alone (24% vs. 61%, p <.001). Youth with symptoms of posttraumatic stress syndrome reported more traumatic events (mean number of events: 28 vs.16). Trauma history was strongly associated with physical, psychological, and social problems. Most frequent strategies to combat sadness were praying (55.3%), sleeping (39.9%), reading (32.3%), and talking to friends (27.8%).
Many young Somali and Oromo immigrants to the United States experience life problems associated with war trauma and torture, but many others are coping well. The findings suggest a need to develop age-appropriate strategies to promote the health of refugee youth to facilitate their successful adaptation to adult life in the United States.
Journal of Adolescent Health 07/2004; 35(1):17-25. · 3.33 Impact Factor
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ABSTRACT: This study examined prevalence of sexual risks among homeless adolescents and described factors associated with those risks. Community-based outreach methods were used successfully to access this difficult-to-reach population. The sample included 203 homeless youth aged 15–22 recruited from community sites. Questionnaire items addressed demographics, sexual behaviors, alcohol/drug use, STI history and testing, and pregnancy history. In cross-sectional analysis, 58.7% of males and 75.6% of females reported recent sexual intercourse. Of those, one third of males and half of the females used no barrier method with at least one partner. Both gender (female) and race/ethnicity (non-Black) were associated with having intercourse without a barrier contraceptive method. Over one fifth reported a history of survival sex or receiving money, drugs, clothing, shelter, or food for sex. These results show disturbingly high rates of a number of sexual risks, reinforcing the need for targeted interventions with this highly vulnerable population.
Journal of Youth and Adolescence 01/2004; 33(1):71-80. · 2.72 Impact Factor
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Alternative therapies in health and medicine 17(2):46-7. · 1.77 Impact Factor
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ABSTRACT: Low income, medically underserved communities are at increased risk for tuberculosis. Limited population-based national data are available about tuberculous infection in young people from such backgrounds. To determine the prevalence of a positive tuberculin skin test among economically disadvantaged youth in a federally funded job training program during 1995 and 1996, the authors evaluated data from medical records of 22,565 randomly selected students from over 100 job training centers throughout the United States. An estimated 5.6% of students had a documented positive skin test or history of active tuberculosis. Rates were highest among those who were racial/ethnic minorities, foreign born, and (among foreign-born students) older in age ( p < 0.001). Weighted rates (adjusting for sampling) were 1.3% for white, 2.2% for Native American, 4.0% for black, 9.6% for Hispanic, and 40.7% for Asian/Pacific Islander students; rates were 2.4% for US-born and 32.7% for foreign-born students. Differences by geographic region of residence were not significant after adjusting for other demographic factors. Tuberculin screening of socioeconomically disadvantaged youth such as evaluated in this study provides important sentinel surveillance data concerning groups at risk for tuberculous infection and allows recommended public health interventions to be offered. Am J Epidemiol 1999; 149:671–9.
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ABSTRACT: The purpose of this study was to describe the knowledge and attitudes of nursing faculty and students (BSN and MS) regarding complementary/alternative therapies (C/AT) and their integration into nursing practice. Implications for curricular and faculty development were also identified. A cross-sectional survey (n = 170) of graduating BSN students (n = 73) and MS and PhD students (n = 47) and faculty (n = 50) was conducted in a university-based nursing program. The self-administered questionnaire contained 134 forced choice items. Questions assessed attitudes and knowledge about training in, personal use of, perceived barriers to, and intent to integrate C/AT into clinical practice. Over 95 percent of the students and faculty agreed that clinical care should integrate the best of conventional and C/AT practices. Few had received formal C/AT education; the highest number had received some education about massage, music, prayer/spiritual healing, and therapeutic/healing touch. They desired more education but not necessarily the skills to perform these therapies themselves. Faculty and students expressed positive attitudes about incorporating C/AT into curricula and nursing practice. Current knowledge lags behind interest, however, suggesting a situation ripe for change. The most important perceived barrier to incorporation was lack of evidence. Curricular change is needed to fully integrate C/AT in nursing programs at all levels; faculty development and nursing research is needed to facilitate these changes.
Journal of Professional Nursing 19(6):387-97. · 0.89 Impact Factor
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ABSTRACT: To describe Papanicolaou (Pap) test findings and identify prevalence and correlates of dysplastic cervical abnormalities in low-income adolescent females.
This cross-sectional study included a modified random sample of female students ages 16 to 25 years at 54 U.S. Job Corps centers.
5,734 female students enrolled in a federal job training program. Admission health records were reviewed and abstracted.
Pap test findings using the Bethesda classifications. Pap smear results indicating dysplasia (atypical squamous cells of undetermined significance [ASCUS] with dysplasia) or squamous intraepithelial lesions (low-grade squamous interepithelial lesions [LGSIL] or high-grade squamous intraepithelial lesions [HGSIL]). Participants with less severe findings were compared with those who needed follow-up.
For 71.4% of participants, no abnormalities were found. 15.6% had benign cellular changes, 9.2% had reactive changes, and 9.9% had epithelial cell abnormalities. Of those tested, 5.6% (+/- 0.8%) had dysplastic Pap smear findings, with 0.3% (n = 12) HGSIL. All groups were equally affected, with abnormalities not associated with race/ethnicity, age, geographic region, education level, size of city of residence, or receiving public assistance.
In this population, dysplastic Pap smear results were not uncommon. Findings indicate that Pap screening, alone or in combination with more sensitive tests, can identify cervical abnormalities, including HGSIL, that suggest a need for further evaluation or follow-up.
Journal of Obstetric Gynecologic & Neonatal Nursing 31(3):294-304. · 1.03 Impact Factor
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ABSTRACT: This study investigated tattooists' attitudes regarding government regulation and the relationship between existing tattooing regulation and tattooists' knowledge and practice of infection control.
Self-reported and observational data were collected in a cross-sectional study of professional tattooists. A written survey was used to investigate knowledge and practice of infection control and attitudes toward government regulation. Infection control practice was also examined through direct observation of tattooing. Rating scales were used to compare tattoo artists subject to local tattooing ordinances with those in areas without ordinances.
Sixty-one tattooists (45 regulated, 16 unregulated) completed surveys and 25 (17 regulated, 8 unregulated) were observed. Attitudes toward regulation were generally positive. Most participants supported health department inspections and training requirements. The presence of local tattooing ordinances was not associated with tattooists' knowledge (p=0.53), but was associated with self-reported practices (p=0.05). A more positive attitude toward regulation was associated with the use of more self-reported infection control procedures (p<0.01).
Tattoo artists in areas with local tattooing ordinances may implement more bloodborne pathogen precautions than those in areas without ordinances, despite working from a similar knowledge base. Tattooists most in need of improvement may be difficult to reach due to opposition to government intrusion. Federal guidelines, clarification of OSHA rules applying to tattooists, and statewide regulation are needed. Tattooists should be involved in the development of regulations.
Public Health Reports 118(2):154-61. · 1.27 Impact Factor
