Brittany L. Rosen

School Nurses’ Professional Practice in the HPV Vaccine Decision-Making Process

Because U.S. human papillomavirus (HPV) vaccination rates remain low, we evaluated school nurses’ knowledge, attitudes, perceptions of their role as opinion leaders, self-efficacy, intention, and professional practice regarding the HPV vaccine and determined if these variables influenced their professional practice concerning the HPV vaccine. We utilized a cross-sectional design by recruiting Ohio Association of School Nurses (OASN) members. Participants (n = 145) completed a paper survey during the OASN annual conference. Structural equation modeling was used to examine the proposed model. Our model yielded a well-fitting solution, χ2 = 1.118 (degrees of freedom = 2, p = .57). Knowledge had positive effects on intention and self-efficacy. Attitude had a positive effect on perception of role as opinion leaders. Intention to provide HPV vaccine education had a positive effect on professional practice. To develop school nurses’ practice, interventions should center on increasing knowledge, attitudes, and intention toward providing HPV vaccine education.

Factors associated with school nurses' HPV vaccine attitudes for school-aged youth.

Abstract School nurses are at the intersection of the healthcare and school communities, thus, they can be considered opinion leaders in providing health advice – including information about the human papillomavirus (HPV) vaccine – to parents and students. This study examined school nurses’ attitudes toward the HPV vaccine based on age, years as a school nurse, geographic location, urban vs. rural work setting, HPV and vaccine knowledge, perception of role as opinion leaders, and school district support in providing health education. Participants (n = 413) were systematically sampled from the National Association of School Nurses’ membership and completed a web-based survey. Multiple regression was used to predict positive HPV vaccine attitudes. The model was statistically significant accounting for 50.8% of the variance (F [9, 400] = 45.96, p < .001). Positive attitudes regarding the HPV vaccine were predicted by higher HPV and vaccine knowledge (β = .096, p < .001) and stronger perceptions of role as opinion leaders for the vaccine (β = .665, p < .001). No other variables were found to be statistically significant. These results suggest knowledge is essential in predicting positive attitudes, but not the strongest predictor as perceptions of role as opinion leaders was more crucial in terms of predicting school nurses’ positive attitudes towards HPV vaccine. Despite school nurses being seen as champions for adolescent vaccines, they need additional professional development to increase their HPV vaccine knowledge and attitudes to encourage parents and adolescents to consider the uptake of HPV vaccination. To engage school nurses’ in promoting HPV vaccine uptake, interventions need to focus on increasing school nurses’ perception of their role as opinion leaders for HPV vaccine and knowledge to increase positive attitudes towards HPV vaccination for youth.

Statistical Significance vs. Practical Significance: An Exploration through Health Education

Abstract The purpose of this paper is to examine the differences between statistical and practical significance, including strengths and criticisms of both methods, as well as provide information surrounding the application of various effect sizes and confidence intervals within health education research. Provided are recommendations, explanations and examples of reporting effect size and confidence intervals. Understanding and integrating practical significance measures provides health education scholars and practitioners with the tools to address issues related to statistical and practical significance.

Conceptualizing and Implementing a Professional Development Pilot Program for Public School Teachers to Strengthen Sexuality Education

Professional development and training efforts are essential components of effective and evidence-based approaches for educators to teach sexuality education. Public school teachers, with and without health professional preparation, are often assigned to teach sexuality units with limited training. Although sexuality-based curriculum trainings have been available to educators, they are rarely implemented for school teachers at the local, regional, or state levels. This article presents a framework for planning and implementing a professional development opportunity for public school teachers occurring outside the school setting. The authors describe a professional training, called the Sexuality Education Academy, developed to assist Texas school health professionals working with students in grades kindergarten through 12 to understand the importance of using evidence-based tools, resources, and practices in their classroom regarding sexuality education. The Sexuality Education Academy approach holds promise for professional development efforts in sexuality education, in addition to evaluating interventions to ensure accurate implementation of evidence-based sexuality education.

Impact of Perceived Risk and Friend Influence on Alcohol and Marijuana Use Among Students

We performed a secondary analysis of Adolescent Health Risk Behavior Survey data (N = 937), examining associations between lifetime alcohol and marijuana use with intrapersonal (i.e., risk perceptions) and interpersonal (e.g., peer approval and behavior) factors. Multinomial and binary logistic regression analyses contend students reporting lifetime alcohol use—compared to students who had never used alcohol or marijuana—perceived lower alcohol risk (p < .001), higher friend drinking approval (p < .001), and greater friend drinking (p = .003). Using both alcohol and marijuana in one’s life was associated with being in public schools (p = .010), higher grade levels (p = .001), lower perceived alcohol (p = .011) and marijuana use risk (p = .003), higher friend approval of alcohol (p < .001) and marijuana use (p < .001), and believed more friends used alcohol (p < .001). Compared to lifetime alcohol only, perceived friend academic performance decreased the risk of lifetime alcohol and marijuana use (p = .043). Findings are beneficial to school nurses with students experiencing effects associated with substance use.

HPV Vaccination Status and Mandate Support for School-Aged Adolescents Among College Females: A Descriptive Study.

The purpose of this study was to describe college-aged females’ human papillomavirus (HPV) knowledge and beliefs, perceptions and perceived benefits of the HPV vaccine, and identify characteristics associated with vaccination status and support for HPV vaccine mandates. Data were collected from 1,105 females by an Internet-delivered questionnaire during February to March 2011. This descriptive study utilizes χ2 tests and t-tests to compare participant responses. HPV-related knowledge scores were 8.08 out of 11 points. Those who initiated HPV vaccination were significantly younger, single, engaged in sex, were sexually active, and had a Pap test. Participants who had more friends receiving the vaccine were significantly more likely to support mandates for 9–11 and 12–17 years and were more likely to complete the HPV vaccination cycle. Findings suggest the importance of educational programs adopted and delivered by school nurses, which aim to improve student knowledge and reduce misconceptions related to the HPV vaccine and vaccination mandates.

Human Papillomavirus Vaccine Sources of Information and Adolescents’ Knowledge and Perceptions:

Understanding where adolescents obtain information about human papillomavirus (HPV) vaccines may be helpful in designing public health interventions promoting HPV vaccination. This study assessed the following: (1) exposure to specific sources of information about HPV vaccines, (2) self-reported helpfulness of these sources of information, and (3) whether the specific source of information was associated with knowledge and perceptions about HPV vaccines among adolescent girls. There were 339 adolescent girls (mean age = 16.8 years) recruited into the study. Television advertisements, the Internet, doctors/nurses, and mothers were the most frequently reported sources of vaccine information; more than 90% of participants who received information from these sources reported they were helpful. Adolescents who received information about HPV vaccines from television advertisements, the Internet, clinicians, and mothers had higher knowledge about HPV vaccines and more positive perceptions. Assuring the accuracy of messages from these sources will be essential, given their importance in influencing adolescents’ knowledge and perceptions about HPV vaccines.

Predictors of flourishing for adolescents with asthma.

Abstract Objective: The purpose of this study was to examine well-being or flourishing of adolescents with asthma as well as factors influencing flourishing for these adolescents. Methods: A secondary analysis of data collected for the 2011–2012 National Survey of Children’s Health was conducted. Flourishing of adolescents with and without asthma was compared. Parent coping and anger, child sex and age and child flourishing were examined for adolescents with asthma. Results: Youth with asthma had lower flourishing than those without this disease. Positive parent coping was related to flourishing, while parent anger negatively influenced flourishing of adolescents with asthma. Interaction terms were significant, indicating that the aforementioned variables interacted with adolescent age and sex. Conclusions: Study results point to a complex relationship between parent- and adolescent-level factors and adolescent well-being. Further research is needed to examine relations among flourishing and health outcomes in youth with asthma.

Factors Associated with College Women’s Personal and Parental Decisions to be Vaccinated Against HPV

The human papillomavirus (HPV) is a public health concern because of its association with cancer. HPV vaccine rates among college students remains low. This is a critical catch-up age for individuals to receive the HPV vaccine and research shows parents still play a role in college students’ medical decision-making. Therefore, the purpose of this study was to examine factors related to college women making a solo decision to initiate the HPV vaccination in comparison to making a joint parent-daughter decision. Data collected using an internet-delivered questionnaire were analyzed from 799 college women who had initiated or completed the HPV vaccination. Multinomial logistic regression was performed to compare study variables on who decided the participant should be vaccinated (self-decision, parent-only decision, joint parent-daughter decision). Participants who were older (OR 1.68, p < 0.001) and sexually active (OR 4.97, p < 0.001) were significantly more likely to have made a solo decision to be vaccinated. Participants who completed the HPV vaccination (OR 0.33, p < 0.001) and those who talked with a parent about the HPV vaccine (OR 0.12, p < 0.001) were significantly less likely to have made a solo decision to be vaccinated. Findings indicate joint parent-daughter decisions may improve HPV vaccination cycle completion.

Social Determinants of Health and Human Papillomavirus Vaccination Among Young Adults, National Health Interview Survey 2016

Human papillomavirus (HPV) vaccination has the potential to reduce the burden of anogenital cancers. Vaccine uptake remains suboptimal, especially among young adults. Social determinants of health (SDOH) are societal level conditions that may indirectly influence health behaviors, including HPV vaccination. The purpose of this study was to assess HPV vaccination and SDOH among young adult women and men. The 2016 National Health Interview Survey was restricted to participants ages 18–26 (n = 3593). The Healthy People 2020 SDOH Framework was used to identify variables for economic stability, health and healthcare, education, social and community context, and neighborhood and built environment. Survey-weighted logistic regression models identified SDOH variables significantly associated with HPV vaccination. Reported HPV vaccination occurred for 45.7% of women and 14.5% of men in the sample. Among women, education determinants—highest level of education completed and English language—were significantly associated with HPV vaccination. Men (adjusted OR 0.65, 95% CI 0.54, 0.79) and women (adjusted OR 0.66, 95% CI 0.49, 0.90) who did not use the Internet to look up health information were at lower odds to be vaccinated for HPV. These findings can inform future HPV vaccine uptake efforts by focusing specifically on these SDOH areas—education and health and healthcare. Identifying SDOH leverage points is critical to promoting HPV vaccination and ultimately reducing HPV-associated cancers.