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ABSTRACT: Effective prevention requires understanding vulnerable populations, early signs of health risks, and the impact of social contexts. We tested a model of co-occurring mental health risks among at-risk youth experiencing school difficulties.
We analyzed data from a random sample of 336 at-risk youth, grades 9-12, who completed a comprehensive risk/protective factors assessment.
Simultaneously controlling for correlations among health risks, we observed systematic associations among risk factors, with generally consistent patterns for males and females.
The findings underscore the importance of developing interventions that incorporate contextual influences and of identifying common adaptable strategies for attenuating co-occurring health risks for at-risk youth.
Journal of Child and Adolescent Psychiatric Nursing 02/2013; 26(1):74-84.
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ABSTRACT: This study extends prior examination of adolescent violence etiology, drawing on an ethnically diverse, community accessed, yet emotionally vulnerable sample (N = 849) of adolescents at-risk for school drop-out. A balanced risk and protective factor framework captured theorized dimensions of strain, coping, and support resources. We tested the combined and unique contribution of risk and protective components spanning individual, peer/school, and family predictor domains, including victimization histories. Hierarchical regressions yielded significant overall explanation of violent behaviors as well as unique predictors within each of the three domains. Tests for sex differences and moderating effects suggested that levels of risk and protective factors differed for males and females, although the functional relationships to violence were the same for both sexes. Results are discussed relative to prevention and early intervention programs; particularly the importance of understanding adolescent violent behaviors within a context that addresses stress and distress.
Journal of Youth Studies 06/2011; 14(4):413-429. · 1.38 Impact Factor
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ABSTRACT: We examined multi-system influences on risky sexual behavior measured by cumulative sexual risk index and number of nonromantic sexual partners among 4,465 single, sexually experienced adolescents. Hierarchical Poisson regression analyses were conducted with Wave I-II data from the National Longitudinal Study of Adolescent Health. Individual and family factors predicted both outcome measures. Neighborhood set predicted cumulative sexual risk index only, and peer factors predicted the number of nonromantic sexual partners only. School set did not predict either outcome. There were significant associations among risky sexual behavior, drug use, and delinquent behaviors. The results highlight the need for multifaceted prevention programs that address relevant factors related to family, peer and neighborhood influence as well as individual factors among sexually active adolescents.
Research in Nursing & Health 12/2010; 33(6):512-27. · 1.71 Impact Factor
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ABSTRACT: To compare the influence of functional level, ambulatory, and physical activity performance on self-reported health status and quality of life (QOL) of youth with cerebral palsy (CP) and with typical development.
A cross-sectional comparison cohort design was used in 81 youth with CP, ages 10 to 13 years and 30 youth with typical development. Participants wore the StepWatch monitor for 7 days and completed the Activity Scale for Kids, Child Health Questionnaire-Child Form, and Youth Quality of Life Questionnaire. Multiple regression analysis was used.
Self-reported activity performance influenced self-reported physical (beta = 0.36), behavioral (beta = 0.32), and emotional (beta = 0.29) health. Functional level and performance did not influence QOL.
Measures of ambulatory and physical activity and youth-reported health status separated from the measure of QOL seem helpful in defining the specific health issues of ambulatory youth with CP and have implications for physical activity intervention.
Pediatric physical therapy: the official publication of the Section on Pediatrics of the American Physical Therapy Association 02/2008; 20(3):247-53.
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ABSTRACT: This study aimed to test the preliminary psychometric properties of the Scale of Body Connection (SBC), a 20-item self-report measure, designed to assess body awareness and bodily dissociation in mind-body intervention research.
The SBC items were based on common expressions of awareness in body therapy. Content validity was established by a panel of experts. The validity and reliability of the scale was examined with an undergraduate sample. To assess the scale's discriminant validity, the respondents were asked to indicate exposure to specific traumas.
Confirmatory factor analysis, used to examine the scale's construct validity, indicated acceptable goodness-of-fit indices, and revealed uncorrelated subscales, reflecting independent dimensions. Cronbach's alpha revealed equal internal consistency reliability for each subscale for both men and women. Body awareness scores did not differ between individuals with and without reported trauma exposure. Bodily dissociation scores differed between individuals with and without past experience with physical trauma, suggesting the applicability of this subscale for use with populations with trauma histories.
The results provide preliminary evidence of the construct validity and internal consistency reliability of the SBC.
The Journal of Alternative and Complementary Medicine 12/2007; 13(9):945-53. · 1.59 Impact Factor
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ABSTRACT: The purpose of this study was to assess the reliability and validity characteristics of two new scales that measure self-efficacy expectations (Self-Efficacy Expectations After Implantable Cardioverter Defibrillator Implantation Scale [SE-ICD]) and outcome expectations (Outcome Expectations After ICD Implantation Scale [OE-ICD]) in survivors (N = 168) of sudden cardiac arrest, all of whom received an ICD. Cronbach's alpha reliability demonstrated good internal consistency (SE-ICD alpha = .93 and OE-ICD alpha = .81). Correlations with other self-efficacy instruments (general self-efficacy and social self-efficacy) were consistently high. The instruments were responsive to change across time with effect sizes of .46 for SE-ICD and .26 for OE-ICD. These reliable, valid, and responsive instruments for measurement of self-efficacy expectations and outcome expectations after an ICD can be used in research and clinical settings.
Applied Nursing Research 09/2007; 20(3):116-24. · 1.22 Impact Factor
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Journal for Specialists in Pediatric Nursing 05/2007; 12(2):119-22. · 0.83 Impact Factor
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ABSTRACT: The purpose of this study was to explore ethnic and generational influences among Chinese, Filipino, and Euro American adolescents on emotional distress and risk behaviors. Hierarchical multiple regression analyses were conducted with 216 Chinese, 387 Filipino, and 400 Euro American adolescents from the National Longitudinal Study on Adolescent Health to investigate the influence of ethnicity on depression, somatic symptoms, delinquency, and substance use; and to examine the influence of generation on the outcome variables among Chinese and Filipino American adolescents. Ethnicity predicted depression and delinquency scores, while generation within ethnic groups predicted somatic symptoms and substance use. The findings diverge from theories using acculturation as an explanatory mechanism for distress and risk behaviors and underscore the importance of examining sub-groups and generations of Asian American youth.
Research in Nursing & Health 09/2006; 29(4):311-24. · 1.71 Impact Factor
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ABSTRACT: The purpose of this study was to determine the long-term benefits of participating in a structured, 8-week educational telephone intervention delivered by expert cardiovascular nurses post-ICD. The intervention was aimed to (1) increase physical functioning, (2) increase psychological adjustment, (3) improve self-efficacy in managing the challenges of ICD recovery, and (4) lower levels of health care utilization over usual care in the first 12 months post-ICD. This article reports on the 6- and 12-month outcomes of the nursing intervention trial.
A two-group (N = 168) randomized control group design was used to evaluate intervention efficacy with persons receiving an ICD for the secondary prevention of sudden cardiac arrest. Measures were obtained at baseline, 6 and 12 months post hospitalization. Outcomes included (1) physical functioning (Patient Concerns Assessment [PCA], Short Form Health Survey [SF-12], ICD shocks), (2) psychological adjustment (State-Trait Anxiety Inventory [STAI], Centers for Epidemiologic Studies-Depression [CES-D], fear of dying), (3) self-efficacy (Sudden Cardiac Arrest-Self-Efficacy [SCA-SE], Sudden Cardiac Arrest-Behavior [SCA-B], Sudden Cardiac Arrest-Knowledge [SCA-K]), and (4) health care utilization (emergency room [ER] visits, outpatient visits, hospitalizations). Using repeated measures ANOVA, the 6- and 12-month benefits of the intervention over usual care were in reductions in physical concerns (P = 0.006), anxiety (P = 0.04), and fear of dying (P = 0.01), with enhanced self-confidence (P = 0.04) and knowledge (P = 0.001) to manage ICD recovery. There were no statistically significant differences between the groups on total outpatient visits, hospitalizations, or ER visits over 12 months.
A structured 8-week post-hospital telephone nursing intervention after an ICD had sustained 12-month improvements on patient concerns, anxiety, fear of dying, self-efficacy, and knowledge. Results may not apply to individuals with congestive heart failure who receive an ICD for primary prevention of sudden cardiac arrest.
Pacing and Clinical Electrophysiology 12/2005; 28(11):1157-67. · 1.35 Impact Factor
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ABSTRACT: The purpose of this study was to explore the roles of anxiety, depression, and hopelessness as mediators between known risk factors and suicidal behaviors among 1,287 potential high school dropouts. As a step toward theory development, a model was tested that posited the relationships among these variables and their effects on suicidal behaviors. Structural equation models, estimated separately by gender, revealed support for the model, and substantial similarities between males and females. The results showed direct effects of depression and hopelessness on suicidal behaviors for males, and direct effects of hopelessness, but not depression, for females. For both males and females, anxiety was directly linked to depression and hopelessness; drug involvement had both direct and indirect effects on suicidal behavior. As hypothesized, lack of family support showed indirect influences on suicidal behaviors through anxiety for both males and females. The results have important implications for future model development regarding adolescent suicidal behaviors.
Suicide and Life-Threatening Behavior 03/2005; 35(1):14-34. · 1.33 Impact Factor
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ABSTRACT: The ICD is a common therapy for treatment of ventricular arrhythmias and prevention of sudden cardiac death. After ICD therapy, 50% of survivors are known to have significantly elevated anxiety, depression, anger, and fear in getting back to normal physical activities. Despite these problems, few interventions to improve adjustment have been rigorously evaluated within a clinical trial format. This article reports the short-term efficacy of a structured weekly educational telephone intervention (8 weeks) delivered by expert cardiovascular nurses to recipients of an ICD. To test these effects, a two-group (n = 84/group) randomized clinical trial design was used with measures at baseline (hospital discharge), 1 month, and 3 months after ICD therapy. The study sample were first time ICD recipients for secondary prevention of sudden cardiac arrest. Primary outcomes included (1) physical functioning (Patient Concerns Assessment [PCA], Short-Form Health Survey [SF-12], ICD shocks), (2) psychological adjustment (State-Trait Anxiety Inventory [STAI]), Centers for Epidemiologic Studies-Depression (CES-D), (3) knowledge (Sudden Cardiac Arrest [SCA] knowledge assessment), and (4) health care use (emergency room visits, outpatient visits, hospitalizations). The intervention group, as compared to the control group, significantly reduced mean PCA symptoms at 1 month (11.3-8.8 vs 9.7-9.3, respectively, P < 0.02), and reduced state anxiety (36.1-31.9 vs 33.1-33.0, respectively, P < 0.08), and enhanced knowledge (21.8-22.4 vs 21.4-21.7, respectively, P < 0.02) at 3 months. The intervention did not significantly impact short-term health care use. A structured telephone intervention delivered during the first 8 weeks after ICD therapy by expert cardiovascular nurses decreased ICD related physical symptoms and anxiety, and increased SCA knowledge over 3 months.
Pacing and Clinical Electrophysiology 12/2004; 27(12):1594-602. · 1.35 Impact Factor
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ABSTRACT: Depression, alcohol use, and suicidal behaviors are common problems among adolescents in the United States. Little is known about how these problem behaviors differ among adolescent, multiethnic females. In this descriptive, cross-sectional study, regression analyses were performed to determine differences in these adolescent problem behaviors among multiethnic females using Latinas as the referent group. The random sample (N = 3,310, aged 12-19 years) included Latinas, and African-, Asian-, Native-, and Euro-American females. Measures included the CES-D, number of drinks each time alcohol was consumed in the past year, and a composite measure of suicidal behaviors. Latinas reported significantly higher risk for adolescent depression than did Euro-American peers and higher risk for alcohol use than did African- and Asian-American peers only. There were no significant differences in risk for suicidal behaviors between Latinas and their peers representing any of the other four ethnic groups. As adolescents of Latin, African, Asian, Native or aboriginal, and European ethnicity live all over the world, the findings inform future studies on adolescent depression, alcohol use, and suicidal behaviors among adolescents representing any of these ethnic groups in any part of the globe.
Health Care For Women International 05/2004; 25(4):296-310. · 0.63 Impact Factor
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ABSTRACT: Depression, alcohol use, and suicidal behaviors are common among adolescents. However, little is known if these problem behaviors differ among ethnically diverse females across the adolescent years. Using the National Longitudinal Study of Adolescent Health database, we conducted regression analyses to compare these problem behaviors in three age cohorts across five ethnic groups of adolescent females. The random sample (N = 3,297, aged 12-19 years) included Latinas, African-, Asian-, Native-, and Euro-American females. There are differences in these problem behaviors between some age cohorts across ethnic groups. Significance and implications of the results to mental health nursing research and practice are described.
Issues in Mental Health Nursing 04/2004; 25(2):147-64.
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ABSTRACT: The purpose of this study was to explore the influence of ethnic and generational differences on perceptions about parent and family relationships in a nationally representative sample of Chinese and Filipino adolescents living in the United States.
This was a cross-sectional descriptive study, utilizing data from the National Longitudinal Study on Adolescent Health.
The sample was weighted to produce a nationally representative sample, based on 216 self-identified Chinese and 387 self-identified Filipino adolescents.
Results indicated that generational status plays a role in predicting how adolescents perceive the parent-adolescent relationship.
Findings provide a basis by which community health nurses can begin to understand the uniqueness of Asian subgroups, as well as generations of immigrant youth.
Public Health Nursing 22(6):460-71. · 0.72 Impact Factor
