Carol L. Skay

Protective Factors in the Lives of Bisexual Adolescents in North America

OBJECTIVES We compared protective factors among bisexual adolescents with those of heterosexual, mostly heterosexual, and gay or lesbian adolescents. METHODS We analyzed 6 school-based surveys in Minnesota and British Columbia. Sexual orientation was measured by gender of sexual partners, attraction, or self-labeling. Protective factors included family connectedness, school connectedness, and religious involvement. General linear models, conducted separately by gender and adjusted for age, tested differences between orientation groups. RESULTS Bisexual adolescents reported significantly less family and school connectedness than did heterosexual and mostly heterosexual adolescents and higher or similar levels of religious involvement. In surveys that measured orientation by self-labeling or attraction, levels of protective factors were generally higher among bisexual than among gay and lesbian respondents. Adolescents with sexual partners of both genders reported levels of protective factors lower than or similar to those of adolescents with same-gender partners. CONCLUSIONS Bisexual adolescents had lower levels of most protective factors than did heterosexual adolescents, which may help explain their higher prevalence of risky behavior. Social connectedness should be monitored by including questions about protective factors in youth health surveys.

Effects of a geriatric nurse practitioner on process and outcome of nursing home care.

We compared measures of quality of care and health services utilization in 30 nursing homes employing geriatric nurse practitioners with those in 30 matched control homes. Information for this analysis came from reviews of samples of patient records drawn at comparable periods before and after the geriatric NPs were employed. The measures of geriatric nurse practitioner impact were based on comparisons of changes from pre-NP to post-NP periods. Separate analyses were done for newly admitted and long-stay residents; a subgroup of homes judged to be best case examples was analyzed separately as well as the whole sample. Favorable changes were seen in two out of eight activity of daily living (ADL) measures: five of 18 nursing therapies; two of six drug therapies; six of eight tracers. There was some reduction in hospital admissions and total days in geriatric NP homes. Overall measures of medical attention showed a mixed pattern with some evidence of geriatric NP care substituted for physician care. These findings suggest that the geriatric NP has a useful role in nursing home care.

Sexual Orientation, Sexual Abuse, and HIV-Risk Behaviors Among Adolescents in the Pacific Northwest

OBJECTIVES We explored HIV risk behaviors, sexual orientation, and sexual abuse among 5 school-based cohorts in Seattle, Wash (SEA95 and SEA99:N=7477 and N=6590), and British Columbia (BC92, BC98, and BC03 [weighted]: N=239975, N=281576, and N=265132). METHODS An HIV risk scale of 7 items assessed risky sexual behaviors and injection drug use. Self-identified sexual orientation included heterosexual, bisexual, gay/lesbian, and, in British Columbia only, mostly heterosexual. Analyses of covariance were conducted separately by gender and were adjusted for age and sexual abuse when comparing means. RESULTS Gay/lesbian and bisexual adolescents had higher mean age-adjusted risk scores compared with heterosexual and mostly heterosexual adolescents. After we controlled for sexual abuse history, mean scores were 2 to 4 times higher among abused students than among nonabused students in each sexual orientation group. Age/abuse-adjusted models better explained the variance in risk scores (R(2)=0.10-0.31), but sexual orientation remained an independent predictor. CONCLUSION Sexual minority adolescents who attended school reported higher HIV risk behaviors, and higher prevalence of sexual victimization may partially explain these risks.

From adolescent connections to social capital: predictors of civic engagement in young adulthood

PURPOSE This study examined the ability of adolescent connection in family and community contexts to promote an aspect of healthy youth development and transition into adulthood, civic engagement. METHODS Data are from Wave 1 (1995) and Wave 3 (2001-2002) of the in-home interviews from the National Longitudinal Study of Adolescent Health. The sample for this study included 9130 young adults aged 18-26 years. Linear and logistic regression models were used to measure the influence of connection in family and community contexts (Wave 1) on outcomes of civic engagement in young adulthood (Wave 3). RESULTS Stronger connection in all family and community contexts during adolescence predicted greater likelihood of voting, community volunteer service, involvement in social action/solidarity groups, education groups, and/or conservation groups, and endorsement of civic trust in young adulthood. Select connections in family and community contexts were also significant predictors of political voice/involvement and blood product donation. In a final multivariate model, frequency of shared activities with parent(s) and school connection during adolescence emerged as unique predictors of young adult civic engagement. CONCLUSIONS Connections in family and community contexts during adolescence promote healthy youth development through facilitation of multiple aspects of civic engagement in young adulthood. The importance of these connections in fostering youth capacity to bond to a broader community construct is discussed.

Suicidal ideation and Attempts in North American School-Based Surveys: Are Bisexual Youth at Increasing Risk?

This study explored the prevalence, disparity, and cohort trends in suicidality among bisexual teens vs. heterosexual and gay/lesbian peers in 9 population-based high school surveys in Canada and the U.S. Multivariate logistic regressions were used to calculate age-adjusted odds ratios separately by gender; 95% confidence intervals tested cohort trends where surveys were repeated over multiple years. Results showed remarkable consistency: bisexual youth reported higher odds of recent suicidal ideation and attempts vs. heterosexual peers, with increasing odds in most surveys over the past decade. Results compared to gay and lesbian peers were mixed, with varying gender differences in prevalence and disparity trends in the different regions.

Family and Racial Factors Associated With Suicide and Emotional Distress Among Latino Students

BACKGROUND Latino youth experience disproportionate rates of mental health problems including suicide and depression. Better understanding of underlying risk and protective factors on the part of school-based health professionals, teachers, and health care providers in their lives is warranted. The aims of this secondary analysis of 2004 Minnesota Student Survey data were to (1) describe the mental health status of a statewide sample of Latino 9th- and 12th-grade students; (2) explore relationships of family protective factors (communication, caring, and connection) with suicidal ideation, suicidal attempts, and emotional distress; and (3) highlight similarities and differences in family protective factors among subgroups of Latino students. METHODS Parallel analyses were completed for Latino-only and Latino-mixed students. Bivariate logistic regression models were used to examine associations between each family variable and each study outcome. RESULTS Nearly 1 in 5 Latino high school students have had suicidal thoughts in the past year; past year suicide attempts ranged from 6% to 18.5% across grade and gender subgroups. Most concerning are ninth-grade Latino girls, a group in which 30-40% reported suicidal thoughts and 14-19% reported attempting suicide in the past year. CONCLUSIONS An important study finding is the high rate of suicidal ideation, suicide attempts, and emotional distress among students who self-identified as being of mixed ethnicity. Study findings can be used to inform mental health promotion initiatives and culturally tailor interventions with Latino students.

Improving Primary Care in Nursing Homes

We conducted a quasi‐experiment to evaluate the impact of a Medicare waiver which allowed the use of nurse practitioners (NPs) and physicians assistants (PAs) to deliver primary care to Massachusetts nursing home patients and removed the limits on the reimbursable numbers of visits per month. A carefully matched set of 1,327 Medicaid patients from 95 non‐participating homes in the same areas of Massachusetts was compared to 1,324 Medicaid demonstration patients from 75 homes. Information came from specially designed record reviews and the Medicaid and Medicare information systems. Separate analyses were done for newly admitted cases and rollovers. Comparisons of quality of care suggested that the medical groups using NPs and PAs provided as good or better care than did the physicians in the control group. There were no differences in functional status changes or in the use of medications. The demonstration patients received more attention, as reflected in more orders written and an average of one additional visit a month. Demonstration patients showed higher scores on three of seven specially designed quality tracers, congestive heart failure and hypertension for both new admissions and rollovers, and new urinary incontinence for new admissions. Rollovers had significantly fewer emergency and total hospital days. A cost analysis suggests that the use of NPs and PAs saves at least as much as it costs and may save additional money with more sustained use.

Multidimensional Scaling and Factor Models of Test and Item Responses

This article discusses 2 alternatives to the factor model for test or item responses. From the two alternative models, proximity measures are derived so that the proximity measures are within an additive constant of squared euclidean distances between item or test parameters. Hence, multidimensional scaling (MDS) can be used to estimate the item parameters in the alternative models. Solutions that are based on the models are compared. In light of the response models, interpretation and appropriateness of factor and MDS solutions are discussed

Self-management development in children and adolescents with diabetes: the role of maternal self-efficacy and conflict.

The overall purpose of this study was to investigate maternal self-efficacy and its relationship to maternal perception of the childs self-management of diabetes. The influence of conflict between mother and child was also examined. One hundred and four mothers of children, ages 8 to 17 years, who were attending summer diabetes camp, were asked to rate their own and their childs abilities to manage the childs diabetes. Overall, the mothers expressed a high degree of self-efficacy in managing their childs diabetes and perceived their children as average or above in managing their own diabetes when compared with agemates with diabetes. Furthermore, mothers level of self-efficacy was significantly positively related to their perceptions of their childs self-management. In addition, almost one third (30%) of the mothers reported experiencing interpersonal conflict regarding how much responsibility the child should assume in managing their own diabetes. Mothers who rated their childs level of independence as low were three times more likely to report experiencing conflict. In the vast majority of cases, the child was the primary source of conflict. When hierarchical logistic regression was used to multivariately model childrens independence, conflict with the child remained a significant predictor, above and beyond background, demographic, and important conceptual variables, including self-efficacy.

Protecting Urban American Indian Young People from Suicide.

OBJECTIVE To examine the likelihood of a past suicide attempt for urban American Indian boys and girls, given salient risk and protective factors. METHODS Survey data from 569 urban American Indian, ages 9-15, in-school youths. Logistic regression determined probabilities of past suicide attempts. RESULTS For girls, suicidal histories were associated with substance use (risk) and positive mood (protective); probabilities ranged from 6.0% to 57.0%. For boys, probabilities for models with violence perpetration (risk), parent prosocial behavior norms (protective), and positive mood (protective) ranged from 1.0% to 38.0%. CONCLUSIONS Highlights the value of assessing both risk and protective factors for suicidal vulnerability and prioritizing prevention strategies.