Carolyn M. Garcia

Adolescent health literacy: the importance of credible sources for online health information.

BACKGROUND Little research has examined adolescent health literacy and its relationship with online health information sources. The purpose of this study is to explore health literacy among a predominantly Hispanic adolescent population and to investigate whether exposure to a credible source of online health information, MedlinePlus(®), is associated with higher levels of health literacy. METHODS An online survey was administered to a cross-sectional random sample of high school students in South Texas. Self-reported sociodemographic characteristics and data on health-information-seeking behavior and exposure to MedlinePlus(®) were collected. Health literacy was assessed by eHEALS and the Newest Vital Sign (NVS). Linear and binary logistic regressions were completed. RESULTS Of the 261 students who completed the survey, 56% had heard of MedlinePlus(®), 52% had adequate levels of health literacy as measured by NVS, and the mean eHEALS score was 30.6 (possible range 8-40). Health literacy was positively associated with self-efficacy and seeking health information online. Exposure to MedlinePlus(®) was associated with higher eHealth literacy scores (p < .001) and increased the likelihood of having adequate health literacy (odds ratio: 2.1; 95% CI: 1.1, 4.1). CONCLUSION Exposure to a credible source of online health information is associated with higher levels of health literacy. The incorporation of a credible online health information resource into school health education curricula is a promising approach for promoting health literacy.

Conceptualization and measurement of coping during adolescence: a review of the literature

PURPOSE The purpose of this review was to examine the conceptualization and measurement of coping in adolescent research. DESIGN A review of the literature published and abstracted in four scientific databases was undertaken between July 2008 and June 2009 with the following key words: adolescent(s), cope/coping, stress(ors), and adaptation/psychological. METHODS A total of 367 articles were initially identified, and review of published abstracts yielded 104 empirical articles to retrieve and examine more closely for inclusion. Criteria for inclusion in the review were that the study (a) measured coping, (b) presented original data, (c) primarily targeted adolescent participants, (d) was reported in English, and (e) was published between 1998 and June 2009. Fifty-nine subsequent articles were organized using a matrix approach that facilitated cross-study comparisons of purpose, sample, and dependent variables. FINDINGS Fewer than half of the studies reviewed included a specific statement defining coping. Instead, many authors described coping in the context of stress response by identifying particular types or ways of coping or naming specific coping strategies used. The theoretical frameworks guiding examination of coping varied across studies. A range of measures, congruent with adolescent developmental processes, were used to assess adolescent coping. A wide range of stress-related risks or conditions were examined, including psychological stressors such as eating disorders, suicidal ideation, and depression; physical stressors such as chronic illness, HIV infection, sports participation, violence, or sexual abuse; familial stressors such as domestic violence or interparental conflict; social stressors such as romantic relationships or difficulties in settings such as school, prison, or a homeless shelter; and societal stressors such as discrimination. CONCLUSIONS Coping is an important construct in understanding how adolescents react to the extensive stressors and adjustments they experience. Coping is a complex construct yet worthy of examination because it can be a critical point of intervention in the health trajectory of adolescents and young people. Research is needed to advance the conceptualization and measurement of adolescent coping such that interpretation of findings across studies is enhanced. In this way, future research, including interventions targeting coping, will work synergistically to advance the science and adolescent well-being. CLINICAL RELEVANCE Nursing and other healthcare providers working with adolescents understand the need for interventions that promote use of healthy coping strategies and minimize unhealthy coping. Findings from this study demonstrate the state of coping conceptualization and measurement in adolescent research and indicate a need for research that will advance the science and improve the usefulness of adolescent coping data.

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.

Conducting Go-Along Interviews to Understand Context and Promote Health

Go-along interviewing is an innovative approach to obtaining contextualized perspectives by conducting mobile interviews in which the participant acts as a navigational guide of the real or virtual space within which he or she lives. In this study, we used go-along interviews to obtain college students’ contextualized perceptions of sexual health resources. Seventy-eight undergraduate students showed and described the resources on and near five campuses in a Midwestern state. In this article, we focus on the methodology of go-along interviews. The go-along, a relatively new methodology in health research, is a format in which participants take an active role in shaping the interview, and it facilitates identification of resources that might be overlooked using traditional interview formats. The go-along methodology is promising for researchers wanting to ground health-promotion efforts in the context of environmental or community-based strengths and needs.

Barriers to care in an ethnically diverse publicly insured population: Is health care reform enough?

Background:The Affordable Care Act provides for the expansion of Medicaid, which may result in as many as 16 million people gaining health insurance coverage. Yet it is unclear to what extent this coverage expansion will meaningfully increase access to health care. Objective:The objective of the study was to identify barriers that may persist even after individuals are moved to insurance and to explore racial/ethnic variation in problems accessing health care services. Research Design:Data are from a 2008 cross-sectional mixed-mode survey (mail with telephone follow-up in 4 languages), which is unique in measuring a comprehensive set of barriers and in focusing on several select understudied ethnic groups. We examine racial/ethnic variation in cost and coverage, access, and provider-related barriers. The study adhered to a community-based participatory research process. Subjects:Surveys were obtained from a stratified random sample of adults enrolled in Minnesota Health Care Programs who self-report ethnicity as white, African American, American Indian, Hispanic, Hmong, or Somali (n=1731). Results:All enrollees reported barriers to getting needed care; enrollees from minority cultural groups (Hmong and American Indian in particular) were more likely to experience problems than whites. Barriers associated with cost and coverage were the most prevalent, with 72% of enrollees reporting 1 or more of these problems. Approximately 63% of enrollees reported 1 or more access barriers. Provider-related barriers were the least prevalent (about 29%) yet revealed the most pervasive disparities. Conclusions:Many challenges to care persist for publicly insured adults, particularly minority racial and ethnic groups. The ACA expansion of Medicaid, although necessary, is not sufficient for achieving improved and equitable access to care.

Characterizing Sexual Health Resources on College Campuses

This observational study describes the development of the college resources and sexual health inventory, the profile of sexual health promotion resources at participating colleges, and comparisons of resources across several college characteristics. 28 diverse college campuses in one Midwestern state participated. 10 domains were assessed, including characteristics of campus health services (e.g. convenience), condom programs, sexual health information, communication about resources, sexual violence resources and gay/lesbian/bisexual student resources. Scores for each measure reflected the presence or extent of each resource. Summary scores were created for the overall level of sexual health resources and for each domain. T tests and ANOVAs were used to compare resources at 2-year versus 4-year colleges, public versus private sectors, metro versus non-metro locations, and across enrollment size. Inventory scores ranged from 6 to 53. 4-year colleges offered significantly more resources than 2-year; resource levels were statistically similar across location and enrollment size. Subsequent analyses comparing campuses with and without a health center indicated that several resources which were not inherently tied to a clinic nonetheless differed significantly with having a health center. Colleges without this resource could position sexual health resources in other offices or departments or provide referrals to sexual health resources in the broader community.

Preventing sexual violence instead of just responding to it: students' perceptions of sexual violence resources on campus.

&NA; Rates of sexual assault of college students are higher than the national rates. Colleges are uniquely positioned to offer preventive education and support services to a high‐risk group. This qualitative study examines students’ perceptions of sexual violence resources and services. Seventy‐eight female and male students, between 18 and 24 years old, belonging to various demographic groups, participated in one‐to‐one walking interviews on five diverse Midwest 2‐ and 4‐year postsecondary campuses. Findings suggest that students are concerned with safety—students want more education regarding sexual violence—and they value services that offer protection from incidents of sexual violence on campus. Participants expressed mixed reactions to prevention education that combined sexual violence prevention with alcohol and drug use. Students shared positive views of the security measures on campus. They emphasized the importance of using varied mechanisms for sexual violence‐related resource messaging and advised moving away from the pamphlet toward posters and online resources. Recommendations are offered to strengthen existing resources, such as prevention education and postassault interventions including sexual assault nurse examiner services, and to minimize barriers to access of sexual violence resources.Rates of sexual assault of college students are higher than the national rates. Colleges are uniquely positioned to offer preventive education and support services to a high-risk group. This qualitative study examines students’ perceptions of sexual violence resources and services. Seventy-eight female and male students, between 18 and 24 years old, belonging to various demographic groups, participated in one-to-one walking interviews on five diverse Midwest 2- and 4-year postsecondary campuses. Findings suggest that students are concerned with safety—students want more education regarding sexual violence—and they value services that offer protection from incidents of sexual violence on campus. Participants expressed mixed reactions to prevention education that combined sexual violence prevention with alcohol and drug use. Students shared positive views of the security measures on campus. They emphasized the importance of using varied mechanisms for sexual violence-related resource messaging and advised moving away from the pamphlet toward posters and online resources. Recommendations are offered to strengthen existing resources, such as prevention education and postassault interventions including sexual assault nurse examiner services, and to minimize barriers to access of sexual violence resources.

College students' sexual health: personal responsibility or the responsibility of the college?

Abstract Objective: This article examines students’ perceptions of individual and institutional responsibility for sexual health so that institutions can better provide for the needs of their students to increase academic success and healthy relationship outcomes. Participants: Students from 2- and 4-year colleges in 1 state (N = 78). Methods: From May through November 2010, the authors used go-along interviews to examine students’ perceptions of resources for sexual health on their campuses. Results: Participants believed that it is the colleges responsibility to provide resources and the responsibility of students to access resources. Participants at 2-year schools wanted referrals to resources, whereas participants at 4-year schools expected resources to be available and emphasized the importance of a supportive community. Conclusions: Students at 2- and 4-year colleges have different expectations of their institutions; by making resources and referrals for sexual health available, colleges can better serve their students, which will result in improved health outcomes.

Health care reform and young adults' access to sexual health care: An Exploration of potential confidentiality implications of the Affordable Care Act

One provision of the 2010 Affordable Care Act is extension of dependent coverage for young adults aged up to 26 years on their parents private insurance plan. This change, meant to increase insurance coverage for young adults, might yield unintended consequences. Confidentiality concerns may be triggered by coverage through parental insurance, particularly regarding sexual health. The existing literature and our original research suggest that actual or perceived limits to confidentiality could influence the decisions of young adults about whether, and where, to seek care for sexual health issues. Further research is needed on the scope and outcomes of these concerns. Possible remedial actions include enhanced policies to protect confidentiality in billing and mechanisms to communicate confidentiality protections to young adults.

Feasibility and acceptability of a school-based coping intervention for Latina adolescents.

Latino girls (Latinas) experience disproportionate rates of emotional distress, including suicidal ideation, which may be indicative of inadequate coping abilities. Prevention of mental health problems, a U.S. public health priority, is particularly critical for Latina adolescents due to lack of access to mental health treatments. The purpose of this study was to examine the feasibility of Project Wings, a 14-session stress management/coping intervention. Latinas in school (ages 15−21) met weekly for 2-hr with two bilingual experienced facilitators to participate in sharing circles, relaxation exercise, and skill building. Intervention participation and post-intervention focus group data were analyzed. Fall semester intervention (n = 10) occurred during school (72% attendance rate); spring semester intervention (n = 11) was after school (84% attendance rate). Focus group data confirmed acceptability. Latina adolescents will participate in a school-based, group-based stress management/coping intervention. The findings offer insights about intervention recruitment and retention that are specifically relevant to school nurses. Future research includes intervention testing using a randomized study design.