Willa M. Doswell

Exploring the relationship among weight race and sexual behaviors among girls.

OBJECTIVE: The relationship between weight and sexual behavior among adolescents is poorly understood. We examined this relationship in a nationally representative sample of high school girls. METHODS: We performed a cross-sectional analysis of self-reported data from 7193 high school girls who completed the 2005 Youth Risk Behavior Surveillance survey. We used multivariate logistic regression to examine associations among 3 weight indices (BMI calculated from self-reported weight and height, perceived weight, and weight misperception) and 6 sexual behaviors (ever had vaginal sex; sex before age 13; ≥4 sexual partners; and alcohol, condom, and oral contraceptive use at last sex) adjusting for age, race/ethnicity, and a history of intimate partner violence. RESULTS: There were no differences in the likelihood of ever having sex on the basis of BMI or weight perception accuracy; however, girls who perceived themselves as overweight were less likely to have ever had sex. Among sexually active girls, those who had low BMI and perceived themselves as overweight or had overweight misperceptions were less likely to report condom use at last sex. Sexually active girls who perceived themselves as overweight were also more likely to have had sex before age 13. Associations between the 3 weight indices and sexual risk behaviors varied across racial/ethnic groups. CONCLUSIONS: Sexual risk behaviors may be more common among girls who are underweight or perceive themselves (accurately or not) to be overweight and vary by racial/ethnic group. This suggests that girls at weight extremes and those from different racial backgrounds may have unique sexual health education and prevention needs.

The Use of Focus Groups to Examine Pubertal Concerns in Preteen Girls: Initial Findings and Implications for Practice and Research

This article presents the findings of four focus groups aimed at discovering the concerns a group of 9- to 12-year-old African American and Hispanic girls (N = 38) had about puberty, the transition to adolescence, and growing up. Among the factors these girls liked about growing up were increasing independence from parents, widening social relations with same- and opposite-sex friends, and an increase in decision making regarding clothes and activities. What they reported as not liking about growing up were an increase in peer pressure, high parental expectations, and more responsibility for their actions in home, school, and recreational activities. Health care for this group must include systematic monitoring of pubertal development and concerns in order to aggressively educate preadolescents to negotiate this period smoothly and to avoid high-risk behaviors that could have negative health and social sequelae during adolescence and adulthood.

Testing the Theory of Reasoned Action in Explaining Sexual Behavior Among African American Young Teen Girls

This study tested the Theory of Reasoned Action to examine the prediction of early sexual behavior among African American young teen girls. Baseline data from a longitudinal randomized clinical trial were used. Between 2001 and 2005, 198 middle-school girls aged 11 to 14 years were recruited. As girls aged, they held more permissive attitudes toward engaging in early sexual behavior and had a higher intention to engage in early sexual behavior. Intention was a significant predictor to explain sexual behavior among the girls. There is a need to develop strategies that promote intention related to delay and prevention of early sexual behavior.

Evaluating the Mental Health of Jordanian Women in Relationships with Intimate Partner Abuse

This study evaluated the mental health consequences of abuse among Jordanian women and tested the effectiveness of using cognitive behavioral interventions to change the level of depression and level of stress among Jordanian women experiencing intimate partner abuse (IPA). A mixed methods design using phenomenology and quasi-experimental research data collection and analysis was implemented. The most commonly reported form of abuse was psychological abuse. Prior to cognitive behavioral intervention, participants demonstrated moderate to severe levels of depression, low levels of perceived social support, moderate to high levels of self-efficacy, and used approach coping skills more frequently than avoidance coping. Cognitive behavioral interventions resulted in decreased depression (p = .003) and decreased stress levels, although this finding did not reach significance (p > .05). Cognitive behavioral interventions are effective interventions when working with women experiencing IPA.

Implications of type 2 diabetes on adolescent reproductive health risk: an expert model.

Purpose The purpose of this article was to summarize scientific knowledge from an expert panel on reproductive health among adolescents with type 2 diabetes (T2D). Methods Using a mental model approach, a panel of experts— representing perspectives on diabetes, adolescents, preconception counseling, and reproductive health—was convened to discuss reproductive health issues for female adolescents with T2D. Results Several critical issues emerged. Compared with adolescents with type 1 diabetes, (1) adolescents with T2D may perceive their disease as less severe and have less experience managing it, putting them at risk for complications; (2) T2D is more prevalent among African Americans, who may be less trusting of the medical establishment; (3) T2D is associated with obesity, and it is often difficult to change one’s lifestyle within family environments practicing sedentary and dietary behaviors leading to obesity; (4) teens with T2D could be more fertile, because obesity is related to earlier puberty; (5) although obese teens with T2D have a higher risk of polycystic ovary syndrome, which is associated with infertility, treatment with metformin can increase fertility; and (6) women with type 2 diabetes are routinely transferred to insulin before or during pregnancy to allow more intensive management. Conclusions Findings from the expert panel provide compelling reasons to provide early, developmentally appropriate, culturally sensitive preconception counseling for teens with T2D.

Comparing Online with Face-to-Face HELPP Intervention in Women Experiencing Intimate Partner Violence

Intimate partner violence (IPV) is a public health problem. The purpose of this study was to compare the effectiveness of the HELPP (Health, Education on Safety, and Legal Support and Resources in IPV Participant Preferred) intervention among IPV survivors. A sequential, transformative mixed-methods design was used. Participants were randomly assigned to one of three study groups: Online (ONL), Face-to-Face (FTF), and Waitlist Control (WLC). The HELPP intervention was offered to 32 adult female participants who were 45.2% Asian, 32.3% White, and 22.5% Black. Outcome measures were anxiety, depression, anger, personal, and social support. In total, 64% (n = 20) of the participants reported having experienced IPV before the age of 18. The anger mean score pre-test to post-test difference was significant for ONL (p < 0.001) and WLC (p = 0.01). The personal and social support pre-test to post-test mean score differences were significant for ONL (p < 0.001; p < 0.001) and WLC (p = 0.01; p = 0.006), respectively. The HELPP intervention (1) decreased anxiety, depression, anger, and (2) increased personal and social support in the ONL group. The HELPP information and intervention was shown to be feasible, acceptable, and effective among IPV survivors compared with participants in the WLC group. The WLC participants displayed (1) increased levels of anxiety, depression, and anger and (2) decreased levels of personal and social support, post-intervention. Further research could be conducted to determine if e-mail alone or e-mail plus mobile devices are more useful modes of delivering interventions.

Exploring the Experience of African Immigrant Mothers Providing Reproductive Health Education to Their Daughters Aged 10 to 14 Years

Introduction: Adolescents have disproportionate rates of unplanned pregnancies and sexually transmitted infections when compared with all other age groups. Mothers are gatekeepers and providers of reproductive health education, which can prevent teen pregnancy and sexually transmitted infections. Reproductive health education provided by African immigrant mothers is influenced by cultural experiences and cultural contexts that are not well understood and have not been studied. This study sought to describe the experience of African mothers living in the United States providing reproductive health education to their daughters aged 10 to 14 years. Method: A qualitative descriptive design was used. Twenty African immigrant mothers were interviewed in a community setting. Qualitative content analysis approach was used for analysis. Results: Three main themes emerged: (1) mothers’ reproductive health education in their country of origin, (2) mothers’ reproductive health communication with their daughters, and (3) changes due to the move to the United States. Discussion: Mothers believed daughters were too young for reproductive health education, leading to conversations with limited content that were frequently triggered by daughters’ exposure to reproductive health education outside the home. Implications: African immigrant mothers may benefit from culturally congruent discussions with health care providers about the reproductive health information they give their daughters.

Spirituality moderates the relationship of psychosocial stress to metabolic risk factors among Afro-Caribbean immigrants in the US Virgin Islands

ObjectiveSpirituality may contribute to the health advantage of foreign-born blacks compared to United States (US)-born blacks. The objective of this study was to test the hypothesis that spirituality attenuates the association of psychosocial stress to stress-associated metabolic risk factors among foreign-born Caribbean blacks living in a US jurisdiction.MethodsData on demographic factors, anthropometric measurements (height, weight, and waist), fasting glucose and insulin, lifestyle behaviors (smoking and alcohol use), psychosocial stress, and spirituality were collected from a population-based sample of 319 Afro-Caribbean immigrants, ages 20 and older, who were recruited between 1995 and 2000 in the Virgin Islands of the United States (USVI). Glucose and insulin measurements were used to estimate insulin resistance by the homeostasis model assessment (HOMA-IR) method. Participants were classified into three levels of spirituality, “low,” “moderate,” and “high,” based on the distribution of spirituality scores. Stepwise regression analyses were used to identify the significant predictors of waist circumference and HOMA-IR within each level of spirituality.ResultsThe predictors of waist circumference and HOMA-IR varied across the levels of spirituality. Psychosocial stress was an independent predictor of waist and HOMA-IR only among participants with a low level of spirituality.ConclusionSpirituality appears to attenuate the association of psychosocial stress to waist circumference and insulin resistance among Afro-Caribbean immigrants in the USVI.

Exploring the Experiences, Challenges, and Approaches of Parish Nurses in Their Community Practice

Purpose: To explore the personal experiences, challenges, and practices of parish nurses in their communities. Method/Design: The overall study used a mixed methods concurrent embedded design to describe parish nurses’ experiences with diabetes education and preconception counseling in their practice. Also included were descriptions of generalized practices. Therefore, this current report will focus on these broader experiences. Focus group data were collected using face-to-face, teleconference, and video conferencing formats with 48 nurses who consider themselves to be parish nurses and analyzed with content analysis. Findings: Four qualitative themes were identified in the data: (1) Gaining Entry Through Trust, (2) Enhanced Focus on Spiritual Caring, (3) Accomplishing Much Despite Challenges, and (4) Practice Making a Difference. Parish nurses are uniquely situated to provide holistic care for the mind, body, and spirit of their patients. Despite the many positive aspects, parish nurses experience unique challenges, such as funding their practice and working independently. Conclusions: The parish nurses can play a vital role in providing holistic care to patients in a faith-based community. Future work is needed to address the challenges of parish nurses such as access to continuing education programs related to health topics of concern to their community members.

Major Depressive Disorder and Cardiovascular Disease in African-American Women

ABSTRACT Major depression is a risk factor for cardiovascular disease (CVD). This study used the National Survey of American Life (NSAL) to examine the co-occurrence of major depressive disorder (MDD) and CVD in a nationally representative sample of African American women (n = 2,216). Results from a series of logistic regression models indicated high rates of MDD and CVD in the sample, and the African American women with MDD were 1.59 times more likely to have CVD compared to those without MDD. High rates of MDD/CVD co-morbidity appeared across those living in and not living in poverty. These individuals demonstrated greater functional impairment and were high users of mental health services. Our findings validate that MDD and CVD co-occur and the need for more holistic interventions are warranted. The interface of co-morbid health conditions is critical to developing integrated models of care. Integrated health care systems are central for improving physical and mental health outcomes. These findings facilitate developing targeted assessment procedures and culturally appropriate treatment interventions. Increased knowledge regarding the role of gender, chronic health conditions, and the burden of mental illness in African American Women provides the opportunity to examine other chronic health conditions co-occurring with MDD.