Pamela A. Kulbok

Dimensions of adolescent health behavior

PURPOSE To determine dimensions of healthy and unhealthy behaviors of young people aged 12 to 21 years to better inform measures of adolescent health behavior and assist in targeting appropriate strategies to promote health. METHODS The study sample (N = 8730), derived from a U.S. national probability sample; 52.3% were female, 67% white, 15% African-American, 18% Hispanic, 22.2% aged 12-13 years, 38.4% aged 14-17 years, and 39.4% aged 18-21 years. Principal components analysis was done to examine the covariance structure of 42 healthy and unhealthy behaviors selected from the behavioral questions of the Youth Risk Behavior Survey (YRBS). RESULTS A four-factor oblique rotation, comprised of 18 variables with factor loadings of.50 or greater, resulted in interpretable and meaningful health behavior factors. Sexual activity, substance use (e.g., alcohol, marijuana, and other drugs), smoking, and exercise factors accounted for 74% of the variance in the composite of healthy and unhealthy behaviors. These four factors were subsequently reproduced on random samples as well as on samples defined by age (12-13 years [excluding sexual activity variables], 14-17 years, 18-21 years), gender, and race (white, African-American, Hispanic). CONCLUSIONS These results provide new information about the consistent structure of sexual activities and exercise behaviors across subgroups defined by age, gender, and racial/ethnic origins, and about differences in clusters of substance use behaviors across ethnic groups. Further study of diverse population-based samples and multiple health-promoting and health-negating behaviors should profile developmental variations and health protective factors in adolescents.

International Experiences in Nursing Education: A Review of the Literature

Service learning and study abroad opportunities have become increasingly popular in nursing education in the past decade. The purpose of this systematic review was to explore existing literature concerning global health experiences in nursing education. Twenty-three empirical articles from 2003 to 2010 were reviewed, building upon existing reviews of international nursing education literature. Research on two-way exchange experiences and models for best practice were found to be lacking. While an array of countries were represented as the visiting or hosting side of the experience, few co-authors from host countries were found, particularly in literature originating from the U.S. The authors recommend that two-way exchange programs be evaluated to identify successful strategies and barriers to success. Ongoing evaluation of exchanges is necessary to ensure continued sustainable partnership and exchange in immersion experiences for nursing students.

New tobacco trends: Waterpipe (hookah) smoking and implications for healthcare providers

Purpose: To inform healthcare providers about waterpipe smoking, a new trend in tobacco use that is gaining popularity among adolescents and young adults. Data sources: American Lung Association Tobacco Policy Alert on Waterpipe Smoking, World Health Organization Tobacco Regulation Advisory Note on Waterpipe Smoking, and pertinent publications available in the literature. Conclusions: Waterpipe smoking is a new trend in tobacco use that is associated with multiple health problems, including addiction. Healthcare providers should be aware of new tobacco trends that may affect patients, such as waterpipe smoking, that are potential gateways to nicotine addiction. Implications for practice: Tobacco comes in many forms, all of which are addicting. Healthcare providers must be knowledgeable about new forms of tobacco to address all types of tobacco use with patients. Healthcare providers also have a responsibility to educate patients about the health risks inherent in these products to help prevent the long‐lasting problem of nicotine addiction.

Advancing Discourse on Health Promotion: Beyond Mainstream Thinking

Attention must be redirected toward health promotion as nursing evaluates the goal of health for all. Confusion regarding health promotion behavior is illustrated by terms with diverse meanings and uses. In a process of critical analysis, five multidisciplinary experts in health promotion responded to a survey targeting the distinction of health promotion, health promotion behavior, health protection behavior, disease prevention behavior, preventive health behavior, health behavior, and healthy lifestyle. Descriptors of health promotion were derived from a multidimensional conception of well-being. Disagreement existed concerning health protection and health behavior. Nursing interventions are linked to reflective discourse regarding health promotion behavior.

Graduate Education for Advanced Practice Public Health Nursing: At the Crossroads

The complexity of public health problems and advancement of science framing public health demand an expansion of traditional educational approaches and curriculum to prepare a futuristic advanced practice public health nursing (APPHN) workforce. This position paper sponsored by the Association of Community Health Nursing Educators challenges nurse educators to apply innovative strategies in preparing public health nursing (PHN) professionals and to expand curriculum paradigms to promote PHNs ecological approach to solving problems. To meet the challenges of ensuring public health in the 21st century, advanced practice public health nurses must have greater foundational knowledge in critical content areas discussed in this document. Competence in these areas will enable advanced practice public health nurses to address future health care challenges such as rapidly changing social structures, escalating knowledge explosion, globalization, and growth of new technologies. This education will prepare nurses to forge new knowledge and establish health care teams to create effective solutions.

From preventive health behavior to health promotion: advancing a positive construct of health.

A concept analysis of preventive health behavior provided the foundation for this review of current health promotion research in nursing. Studies selected for review described or explained behavior for health promotion, illness prevention, or preventive health behavior. The major focus of this critical review is on the conceptualization and measurement of health promotion behaviors being investigated. Despite nursings claim to an holistic idea of health, the biomedical model continues to influence indicators of health behavior and the context for promotion of healthy life styles. Major issues for future health promotion research relate to the lack of attention to theoretical definitions and multidimensional aspects of health behavior, and the triad of national strategies for health promotion are discussed.

Correlates of alcohol and tobacco use among Mexican immigrants in rural North Carolina.

This study examined the relationship among sociodemographic, cultural, and psychological factors associated with alcohol and tobacco use among Mexican immigrants in the rural south. Questionnaires including sociodemographics, alcohol and tobacco use, acculturation, and stress were administered to 173 Mexican immigrants residing in rural eastern North Carolina. Gender, preimmigration use, and occupational/economic stress were significant predictors for alcohol use, with preimmigration use significant for tobacco use, suggesting that alcohol and tobacco use may be related to previous behavior, rather than acculturation to American society. Stress, setting, and preimmigration substance use would be important factors to address in the immigrants health history.

Evaluation of the Interaction Model of Client Health Behavior through the first decade of research.

The Interaction Model of Client Health Behavior was proposed in 1982 as a prescriptive nursing framework. The model is grounded in multidisciplinary perspectives, and early research suggests that the model may be useful for research and practice. The elements of client singularity and health outcomes have been the primary focus of research during the past decade. Statistical analyses have been exploratory. This article concludes that the model is ready for hypothesis testing with more rigorous statistical procedures, more diversity in samples, and more comprehensive use of the model, including the elements of client-professional interaction.

Contextualizing the effects of yoga therapy on diabetes management: a review of the social determinants of physical activity.

This article provides a review of literature both to identify the effects of yoga-based therapy on the management of type 2 diabetes mellitus and to examine the social context of physical activity. Findings from the review indicate that yoga has a positive short-term effect on multiple diabetes-related outcomes; however, long-term effects of yoga therapy on diabetes management remain unclear. The context of the social environment, including interpersonal relationships, community characteristics, and discrimination, influences the adoption and maintenance of health behaviors such as physical activity, including yoga practice. Further research is necessary to determine the extent of this influence.

Changing Health Outcomes of Vulnerable Populations through Nursing's Influence on Neighborhood Built Environment: A Framework for Nursing Research

PURPOSE The purpose of this article is to present a framework for nurses to study the impact of built environment on health, particularly in vulnerable populations. ORGANIZING CONSTRUCT The framework is adapted from Social Determinants of Health and Environmental Health Promotion, a framework describing how physical and social environments interact to influence individual and population health and health disparities via macro, community-level, and interpersonal factors. METHODS The original framework was modified for public health nursing using nursing research evaluating built environment and health, and supplemented with Nightingales theory of nursing and health. FINDINGS The built environment affects health through regional-, neighborhood-, and individual-level factors. Nursing can affect the health of patients by evaluating the neighborhood built environment where patients reside, and by advocating for changes to the built environment. CONCLUSIONS Through development of built environment research, nurses can provide valuable insight into the pathways linking built environment to health of vulnerable populations, providing evidence for public health nurses to advocate for these changes on a neighborhood, state, and federal level. CLINICAL RELEVANCE This framework can be used by public health clinicians to understand the pathways by which the built environment may be affecting the health of their patients, and by researchers to investigate the pathways, and to design and test community interventions.