BackgroundEarly adolescent unintended pregnancy and sexually transmitted infection prevention are... more BackgroundEarly adolescent unintended pregnancy and sexually transmitted infection prevention are significant public health challenges in the United States. Parental influence can help adolescents make responsible and informed sexual health decisions toward delayed sexual debut; yet parents often feel ill equipped to communicate about sex-related topics. Intergenerational games offer a potential strategy to provide life skills training to young adolescents (aged 11-14 years) while engaging them and their parents in communication about sexual health.ObjectiveThis study aims to describe the development of a web-based online sexual health intergenerational adventure game, the Secret of Seven Stones (SSS), using an intervention mapping (IM) approach for developing theory- and evidence-based interventions.MethodsWe followed the IM development steps to describe a theoretical and empirical model for young adolescent sexual health behavior, define target behaviors and change objectives, ide...
International Journal of Environmental Research and Public Health, 2021
We identified factors associated with student nurses’ Human Papillomavirus Vaccine (HPV) vaccinat... more We identified factors associated with student nurses’ Human Papillomavirus Vaccine (HPV) vaccination status and their intention to counsel parents on HPV vaccination. Undergraduate student nurses (N = 153) from a large university in the south participated. Descriptive statistics, chi-squared tests, and independent t-tests (p ≤ 0.05) were used to characterize the students’ vaccination status. Logistic regression was used to identify factors associated with vaccination status. HPV vaccination rates were low. Students who were older and married or living with a partner were less likely to have completed the HPV vaccine series. The most commonly cited reason for non-initiation and non-completion was the lack of provider endorsement. Vaccination status did not differ significantly according to race/ethnicity, religion, skills, or intention to counsel parents. While intentions to counsel parents on HPV vaccination are high among student nurses, interventions to improve vaccination rates a...
The Journal of adolescent health : official publication of the Society for Adolescent Medicine, 2018
The purpose of the research was to examine the feasibility and acceptability of a father-based se... more The purpose of the research was to examine the feasibility and acceptability of a father-based sexual and reproductive health intervention designed to reduce sexual and reproductive (SRH) disparities and increase correct and consistent condom use among Latino adolescent males. The current study conducted in-depth semi-structured interviews with Latino father-son dyads (N=30) designed to elicit perspectives on communication regarding sex and condom use. In addition, the interview protocol included father-son preferences regarding paternal involvement in condom instruction and perceived obstacles and advantages of father direct involvement in education efforts designed to increase correct and consistent condom use among their adolescent sons. Three independent coders conducted both vertical and horizontal analyses of the data to identify emergent themes and reach theoretical saturation. The main findings from this study suggest that Latino fathers can be impactful in shaping Latino ad...
BACKGROUND People experiencing homelessness have higher rates of HIV than those who are stably ho... more BACKGROUND People experiencing homelessness have higher rates of HIV than those who are stably housed. Mental health needs, substance use problems, and issues unique to homelessness such as lack of shelter and transiency need to be considered with regard to HIV prevention. To date, HIV prevention interventions for young adults experiencing homelessness have not specifically addressed modifiable real-time factors such as stress, sexual or drug use urge, or substance use, or been delivered at the time of heightened risk. Real-time, personalized HIV prevention messages may reduce HIV risk behaviors. OBJECTIVE This pilot study tested the initial efficacy of an innovative, smartphone-based, just-in-time adaptive intervention that assessed predictors of HIV risk behaviors in real time and automatically provided behavioral feedback and goal attainment information. METHODS A randomized attention control design was used among young adults experiencing homelessness, aged 18-25 years, recruite...
Homeless youth continue to be disproportionately affected by HIV compared with their housed peers... more Homeless youth continue to be disproportionately affected by HIV compared with their housed peers, with prevalence rates as high as 13%. Yet, HIV prevention in this high-risk population has been only marginally effective. The aim of this study was to use ecological momentary assessments to examine real-time factors to determine the predictors of sexual activity among homeless youth. Youth experiencing homelessness aged between 18 and 24 years were recruited from a drop-in center in Houston, Texas, between August 2015 and May 2016. All the participants received a study-issued mobile phone that prompted brief ecological momentary assessments (EMAs) 5 times a day for 21 days. EMA items assessed near real-time sexual behaviors, cognitions, stress, affect, environmental factors, and environmental circumstances. Participants (N=66) were predominantly male (41/66, 64%) and black (43/66, 66%) with a median age of 20 years. The mean number of EMAs completed by each participant was 45 out of ...
Background Parents play a pivotal role in adolescent sexual health and Human Papillomavirus (HPV)... more Background Parents play a pivotal role in adolescent sexual health and Human Papillomavirus (HPV) vaccination. Nurses are on the frontlines of healthcare and play a critical role in promoting HPV vaccination and parent-child sexual health communication. We enhanced the Families Talking Together (FTT) parent-based sexual health curriculum to include adolescent vaccinations herein, FTT + HPV, and trained student nurses to provide a strong HPV vaccination and parent-child sexual health communication endorsement. Methods Using a randomized attention-controlled trial design, we examined the efficacy of FTT + HPV among 519 parents and their 11–14 year old youth recruited from medically underserved communities between 2015 and 2018. Participants were recruited from 22 after-school programs (e.g., Boys and Girls Clubs) and 19 charter schools. For parents, we examined protective factors including parent-child sexual health communication and parental involvement. For youth, we examined sexual...
Background: Adolescence is a crucial period that influences the uptake of health behavior. While,... more Background: Adolescence is a crucial period that influences the uptake of health behavior. While, few adolescents report discussing sexual health with a healthcare provider youth most frequently identify providers as the first people asked about health issues and wanting providers to address STIs. With over 3 million nurses, RNs are the largest providers of public health, delivering essential services in communities, schools, and public health clinics and are often called upon to deliver sex education to parents. While nurses have positive attitudes toward health promotion and support health promotion practices, they often feel ill-equipped to assume the role of adolescent sexual health educator. Methods: Using a mixed-methods study, a quantitative quasi-experimental pre-post test and qualitative focus group design, we conducted a pilot study with 31 student nurses to determine the impact of receiving education and implementation of an evidenced-based adolescent sexual health interv...
Communities across the United States are increasing efforts to find and count homeless youth. Thi... more Communities across the United States are increasing efforts to find and count homeless youth. This paper presents findings and lessons learned from a community/academic partnership to count homeless youth and conduct an in depth research survey focused on the health needs of this population. Over a 4 week recruitment period, 632 youth were counted and 420 surveyed. Methodological successes included an extended counting period, broader inclusion criteria to capture those in unstable housing, use of student volunteers in health training programs, recruiting from magnet events for high risk youth, and partnering with community agencies to disseminate findings. Strategies that did not facilitate recruitment included respondent driven sampling, street canvassing beyond known hotspots, and having community agencies lead data collection. Surveying was successful in gathering data on reasons for homelessness, history in public systems of care, mental health history and needs, sexual risk behaviors, health status, and substance use. Youth were successfully surveyed across housing types including shelters or transitional housing (n = 205), those in unstable housing such as doubled up with friends or acquaintances (n = 75), and those who were literally on the streets or living in a place not meant for human habitation (n = 140). Most youth completed the self-report survey and provided detailed information about risk behaviors. Recommendations to combine research data collection with counting are presented.
ABSTRACT Background: The application of technology for adolescent sexual health education is incr... more ABSTRACT Background: The application of technology for adolescent sexual health education is increasing, though few studies have examined the use of health games for HIV/STI and pregnancy prevention and less still that focus on parent-child communication. The Secret of Seven Stones (SSS) is a home-based online adventure game designed to transcend the “sex talk” to engage parents and youth (11-14 yrs.) in a developmentally appropriate HIV, STI, and pregnancy prevention educational experience. Purpose: To describe game development, functionality, and prototype usability testing results. Methods: A stepped development process (Intervention Mapping) guided the application of behavioral theory, empiric data, and qualitative (focus group and semi-structured interview) needs assessment from a collaborative parent-youth advisory group. Design documents and an SSS prototype level were developed. Usability tests were conducted using “talk aloud” and rating (survey) protocols with youth (n=6) under laboratory conditions to assess a range of usability parameters including user satisfaction, ease, comfort, credibility, understandability, and motivational appeal. Results: The SSS game addresses over 1300 learning objectives in 15 behavioral domains (covering responsible decision making skills about friendships, dating relationships, and sex) to provide sexual health and life skills training, and improve parent-child communication, monitoring and connectedness. Youth rated the single level prototype as easy to use (67%-83%), comfortable to play (100%), satisfying (67%), understandable (67%), credible (50%-83%), and motivational (50%-83%). Testing identified important interface and functional design strategies to improve the player experience. Conclusions: Further development and feasibility testing is indicated for this innovative collaborative game-based approach to home-based sexual health education.
Childhood cancer survivors (CCS) are at risk of becoming overweight or obese due to treatment eff... more Childhood cancer survivors (CCS) are at risk of becoming overweight or obese due to treatment effects and/or post-treatment behaviors. Parents are key agents influencing child diet and physical activity (PA), which are modifiable risk factors for obesity. A systematic literature review following the PRISMA guidelines was undertaken to evaluate current interventions that include diet and PA elements for CCS to determine if and to what extent parents were included, and whether parent involvement had a significant effect on behavioral outcomes or adiposity. A total of 2,386 potential articles were reviewed and 25 individual studies fulfilled inclusion criteria. Parental involvement was classified into three categories and varied across studies, although most had indirect or no parental involvement. The studies that included direct parental involvement showed positive outcomes on a variety of measures suggesting that increasing parental involvement in interventions for CCS may be one wa...
While health promotion and patient education are central to the scope of practice of professional... more While health promotion and patient education are central to the scope of practice of professional nurses, they often feel ill-equipped to assume the role of sexual health educator and lack adequate knowledge and skills to effectively engage parents in adolescent sexual and reproductive health efforts. Employing a mixed-methods study consisting of both pre- and post-test survey and exit interviews, a pilot study was conducted to assess the impact of implementing a parent-based adolescent sexual health intervention on baccalaureate nursing student outcomes (N = 31). We found statistically significant improvements in student outcome expectancies of parenting strategies, barriers to sexual health communication, self-efficacy, and sexual health counseling experience. Using thematic content analysis of exit interview content, emerging themes were (1) need for increased sexual and reproductive health (SRH) preparation, (2) wanting greater experience and opportunity for involvement in nursing research, and (3) educational gaps in family-focused community public health. Incorporating adolescent sexual health education into public health nursing clinical training can prepare nurses as parent-based adolescent sexual health educators, a core competency for nurses working with families in communities and across all health care delivery settings.
Perspectives on sexual and reproductive health, 2015
HIV disproportionately affects homeless youth, and interventions to date have had minimal success... more HIV disproportionately affects homeless youth, and interventions to date have had minimal success in reducing sexual risk behaviors in this population. Few qualitative studies have been conducted to provide insight into the influence of homelessness-related factors on sexual risk behaviors. A qualitative study with a quantitative component was conducted with a nonprobability sample of 64 homeless youth aged 14-24; participants were recruited from a variety of venues in Houston between October 2013 and March 2014. Thirteen focus group discussions were conducted; thematic analysis was used to identify themes related to HIV risk. Participants were predominantly black (75%), sheltered (67%) and aged 18 or older (77%). Youth discussed how the circumstances of their homelessness and the struggle to meet their immediate needs led to behaviors and experiences that put them at risk for HIV. Three themes emerged: Homeless youth frequently engage in risky sexual behavior, sometimes as a way to...
Although parental communication is effective in reducing adolescent risk behaviors, many parents ... more Although parental communication is effective in reducing adolescent risk behaviors, many parents hesitate to communicate with their children about sex. Community educators can be effective mediators to provide necessary information and skills to parenting adults. Each trained educator can reach many parenting adults producing an exponential effect on sexual health education and communication. Methods: The Building Family Connections (BFC) curriculum was developed to provide information and skills to increase parent-child sexual health communication. During a 2.5-day training, community educators are equipped to provide the 10-hour BFC curriculum to parenting adults in their communities. Objectives: To 1) evaluate the effectiveness of BFC curriculum training for educators, 2) assess uptake and utilization in educators' communities nationwide, and 3) evaluate effectiveness in transferring this information to parenting adults through trained community educators. Results: In May 200...
Background: Parents are important influences in the adolescent sexual decision-making. Even thoug... more Background: Parents are important influences in the adolescent sexual decision-making. Even though several programs aim to educate parents on sexual health communication with their children, there is not much information on retention and continued parent-child communication on sexual health issues. Furthermore, cultural barriers in Hispanics deter continued parent-child communication on sex. Methods: A Spanish-language curriculum, Construyendo Familias Unidas, showed improved knowledge and skills in Hispanic parents in border communities. Follow up data were obtained 12-24 months after the completion of curriculum classes to assess retention of knowledge and skills as well as communication frequency and behaviors. Objectives: The follow up assessment objectives were to 1) test retention of parent knowledge of risk factors for sexually transmitted infections (STIs) and teen pregnancy and 2) assess frequency and behaviors of parenting adult-child communication on sexual health issues....
Background: Parents are important influences in the adolescent sexual decision-making. However, b... more Background: Parents are important influences in the adolescent sexual decision-making. However, barriers such as embarrassment, lack of information, and sensitive topic deter parent-child communication on sex. Two Hispanic economically disadvantaged border communities in Texas with ~20,000 residents are disproportionately affected by outcomes such as teen pregnancies and sexually transmitted infections (STIs). To enhance prevention efforts, it is important to equip Hispanic parents with the tools to communicate with their children about sexual health topics. Methods: A Spanish-language curriculum, Construyendo Familias Unidas, was provided to parenting adults in two border communities in Texas. Participants received 10 hours of training on sexually transmitted infections (STIs), teen pregnancy, contraception, effective parent-child communication, and decision making. Changes in knowledge, attitudes and behaviors were assessed through pre-/post-survey data collected from 2007 to 2009...
Rates of shelter use among homeless youth are low compared to use of other supportive services, y... more Rates of shelter use among homeless youth are low compared to use of other supportive services, yet research on barriers to shelter use has been conducted in limited regions, specifically in West Coast or Midwest cities. Additionally, while studies have generally focused on barriers to shelter use, studies on what might facilitate shelter use are lacking. This study explores barriers and facilitators to shelter use among homeless young adults from a large city in the Southwest region. Focus groups were conducted with a diverse sample of 49 homeless young adults ages 18-24. Drawing on models of health service use, findings were categorized into two domains - attitudinal and access. Themes related to attitudinal barriers include stigma/shame and self-reliance/pride. Attitudinal facilitators include the desire to extricate themselves from street life and turn their lives in a new direction. Access-related themes include barriers such as a lack of shelters and services available to meet the needs of youth, adverse shelter conditions, staff attitudes that are not acceptable to youth, restrictive shelter rules, restrictive definitions of homelessness, and a desire to differentiate themselves from older homeless individuals. Certain characteristics or circumstances (e.g., being pregnant), having supportive others, and shelters' ability to connect them to other services emerged as access facilitators to shelter use. Implications for policymakers, service providers, and future research are discussed.
BackgroundEarly adolescent unintended pregnancy and sexually transmitted infection prevention are... more BackgroundEarly adolescent unintended pregnancy and sexually transmitted infection prevention are significant public health challenges in the United States. Parental influence can help adolescents make responsible and informed sexual health decisions toward delayed sexual debut; yet parents often feel ill equipped to communicate about sex-related topics. Intergenerational games offer a potential strategy to provide life skills training to young adolescents (aged 11-14 years) while engaging them and their parents in communication about sexual health.ObjectiveThis study aims to describe the development of a web-based online sexual health intergenerational adventure game, the Secret of Seven Stones (SSS), using an intervention mapping (IM) approach for developing theory- and evidence-based interventions.MethodsWe followed the IM development steps to describe a theoretical and empirical model for young adolescent sexual health behavior, define target behaviors and change objectives, ide...
International Journal of Environmental Research and Public Health, 2021
We identified factors associated with student nurses’ Human Papillomavirus Vaccine (HPV) vaccinat... more We identified factors associated with student nurses’ Human Papillomavirus Vaccine (HPV) vaccination status and their intention to counsel parents on HPV vaccination. Undergraduate student nurses (N = 153) from a large university in the south participated. Descriptive statistics, chi-squared tests, and independent t-tests (p ≤ 0.05) were used to characterize the students’ vaccination status. Logistic regression was used to identify factors associated with vaccination status. HPV vaccination rates were low. Students who were older and married or living with a partner were less likely to have completed the HPV vaccine series. The most commonly cited reason for non-initiation and non-completion was the lack of provider endorsement. Vaccination status did not differ significantly according to race/ethnicity, religion, skills, or intention to counsel parents. While intentions to counsel parents on HPV vaccination are high among student nurses, interventions to improve vaccination rates a...
The Journal of adolescent health : official publication of the Society for Adolescent Medicine, 2018
The purpose of the research was to examine the feasibility and acceptability of a father-based se... more The purpose of the research was to examine the feasibility and acceptability of a father-based sexual and reproductive health intervention designed to reduce sexual and reproductive (SRH) disparities and increase correct and consistent condom use among Latino adolescent males. The current study conducted in-depth semi-structured interviews with Latino father-son dyads (N=30) designed to elicit perspectives on communication regarding sex and condom use. In addition, the interview protocol included father-son preferences regarding paternal involvement in condom instruction and perceived obstacles and advantages of father direct involvement in education efforts designed to increase correct and consistent condom use among their adolescent sons. Three independent coders conducted both vertical and horizontal analyses of the data to identify emergent themes and reach theoretical saturation. The main findings from this study suggest that Latino fathers can be impactful in shaping Latino ad...
BACKGROUND People experiencing homelessness have higher rates of HIV than those who are stably ho... more BACKGROUND People experiencing homelessness have higher rates of HIV than those who are stably housed. Mental health needs, substance use problems, and issues unique to homelessness such as lack of shelter and transiency need to be considered with regard to HIV prevention. To date, HIV prevention interventions for young adults experiencing homelessness have not specifically addressed modifiable real-time factors such as stress, sexual or drug use urge, or substance use, or been delivered at the time of heightened risk. Real-time, personalized HIV prevention messages may reduce HIV risk behaviors. OBJECTIVE This pilot study tested the initial efficacy of an innovative, smartphone-based, just-in-time adaptive intervention that assessed predictors of HIV risk behaviors in real time and automatically provided behavioral feedback and goal attainment information. METHODS A randomized attention control design was used among young adults experiencing homelessness, aged 18-25 years, recruite...
Homeless youth continue to be disproportionately affected by HIV compared with their housed peers... more Homeless youth continue to be disproportionately affected by HIV compared with their housed peers, with prevalence rates as high as 13%. Yet, HIV prevention in this high-risk population has been only marginally effective. The aim of this study was to use ecological momentary assessments to examine real-time factors to determine the predictors of sexual activity among homeless youth. Youth experiencing homelessness aged between 18 and 24 years were recruited from a drop-in center in Houston, Texas, between August 2015 and May 2016. All the participants received a study-issued mobile phone that prompted brief ecological momentary assessments (EMAs) 5 times a day for 21 days. EMA items assessed near real-time sexual behaviors, cognitions, stress, affect, environmental factors, and environmental circumstances. Participants (N=66) were predominantly male (41/66, 64%) and black (43/66, 66%) with a median age of 20 years. The mean number of EMAs completed by each participant was 45 out of ...
Background Parents play a pivotal role in adolescent sexual health and Human Papillomavirus (HPV)... more Background Parents play a pivotal role in adolescent sexual health and Human Papillomavirus (HPV) vaccination. Nurses are on the frontlines of healthcare and play a critical role in promoting HPV vaccination and parent-child sexual health communication. We enhanced the Families Talking Together (FTT) parent-based sexual health curriculum to include adolescent vaccinations herein, FTT + HPV, and trained student nurses to provide a strong HPV vaccination and parent-child sexual health communication endorsement. Methods Using a randomized attention-controlled trial design, we examined the efficacy of FTT + HPV among 519 parents and their 11–14 year old youth recruited from medically underserved communities between 2015 and 2018. Participants were recruited from 22 after-school programs (e.g., Boys and Girls Clubs) and 19 charter schools. For parents, we examined protective factors including parent-child sexual health communication and parental involvement. For youth, we examined sexual...
Background: Adolescence is a crucial period that influences the uptake of health behavior. While,... more Background: Adolescence is a crucial period that influences the uptake of health behavior. While, few adolescents report discussing sexual health with a healthcare provider youth most frequently identify providers as the first people asked about health issues and wanting providers to address STIs. With over 3 million nurses, RNs are the largest providers of public health, delivering essential services in communities, schools, and public health clinics and are often called upon to deliver sex education to parents. While nurses have positive attitudes toward health promotion and support health promotion practices, they often feel ill-equipped to assume the role of adolescent sexual health educator. Methods: Using a mixed-methods study, a quantitative quasi-experimental pre-post test and qualitative focus group design, we conducted a pilot study with 31 student nurses to determine the impact of receiving education and implementation of an evidenced-based adolescent sexual health interv...
Communities across the United States are increasing efforts to find and count homeless youth. Thi... more Communities across the United States are increasing efforts to find and count homeless youth. This paper presents findings and lessons learned from a community/academic partnership to count homeless youth and conduct an in depth research survey focused on the health needs of this population. Over a 4 week recruitment period, 632 youth were counted and 420 surveyed. Methodological successes included an extended counting period, broader inclusion criteria to capture those in unstable housing, use of student volunteers in health training programs, recruiting from magnet events for high risk youth, and partnering with community agencies to disseminate findings. Strategies that did not facilitate recruitment included respondent driven sampling, street canvassing beyond known hotspots, and having community agencies lead data collection. Surveying was successful in gathering data on reasons for homelessness, history in public systems of care, mental health history and needs, sexual risk behaviors, health status, and substance use. Youth were successfully surveyed across housing types including shelters or transitional housing (n = 205), those in unstable housing such as doubled up with friends or acquaintances (n = 75), and those who were literally on the streets or living in a place not meant for human habitation (n = 140). Most youth completed the self-report survey and provided detailed information about risk behaviors. Recommendations to combine research data collection with counting are presented.
ABSTRACT Background: The application of technology for adolescent sexual health education is incr... more ABSTRACT Background: The application of technology for adolescent sexual health education is increasing, though few studies have examined the use of health games for HIV/STI and pregnancy prevention and less still that focus on parent-child communication. The Secret of Seven Stones (SSS) is a home-based online adventure game designed to transcend the “sex talk” to engage parents and youth (11-14 yrs.) in a developmentally appropriate HIV, STI, and pregnancy prevention educational experience. Purpose: To describe game development, functionality, and prototype usability testing results. Methods: A stepped development process (Intervention Mapping) guided the application of behavioral theory, empiric data, and qualitative (focus group and semi-structured interview) needs assessment from a collaborative parent-youth advisory group. Design documents and an SSS prototype level were developed. Usability tests were conducted using “talk aloud” and rating (survey) protocols with youth (n=6) under laboratory conditions to assess a range of usability parameters including user satisfaction, ease, comfort, credibility, understandability, and motivational appeal. Results: The SSS game addresses over 1300 learning objectives in 15 behavioral domains (covering responsible decision making skills about friendships, dating relationships, and sex) to provide sexual health and life skills training, and improve parent-child communication, monitoring and connectedness. Youth rated the single level prototype as easy to use (67%-83%), comfortable to play (100%), satisfying (67%), understandable (67%), credible (50%-83%), and motivational (50%-83%). Testing identified important interface and functional design strategies to improve the player experience. Conclusions: Further development and feasibility testing is indicated for this innovative collaborative game-based approach to home-based sexual health education.
Childhood cancer survivors (CCS) are at risk of becoming overweight or obese due to treatment eff... more Childhood cancer survivors (CCS) are at risk of becoming overweight or obese due to treatment effects and/or post-treatment behaviors. Parents are key agents influencing child diet and physical activity (PA), which are modifiable risk factors for obesity. A systematic literature review following the PRISMA guidelines was undertaken to evaluate current interventions that include diet and PA elements for CCS to determine if and to what extent parents were included, and whether parent involvement had a significant effect on behavioral outcomes or adiposity. A total of 2,386 potential articles were reviewed and 25 individual studies fulfilled inclusion criteria. Parental involvement was classified into three categories and varied across studies, although most had indirect or no parental involvement. The studies that included direct parental involvement showed positive outcomes on a variety of measures suggesting that increasing parental involvement in interventions for CCS may be one wa...
While health promotion and patient education are central to the scope of practice of professional... more While health promotion and patient education are central to the scope of practice of professional nurses, they often feel ill-equipped to assume the role of sexual health educator and lack adequate knowledge and skills to effectively engage parents in adolescent sexual and reproductive health efforts. Employing a mixed-methods study consisting of both pre- and post-test survey and exit interviews, a pilot study was conducted to assess the impact of implementing a parent-based adolescent sexual health intervention on baccalaureate nursing student outcomes (N = 31). We found statistically significant improvements in student outcome expectancies of parenting strategies, barriers to sexual health communication, self-efficacy, and sexual health counseling experience. Using thematic content analysis of exit interview content, emerging themes were (1) need for increased sexual and reproductive health (SRH) preparation, (2) wanting greater experience and opportunity for involvement in nursing research, and (3) educational gaps in family-focused community public health. Incorporating adolescent sexual health education into public health nursing clinical training can prepare nurses as parent-based adolescent sexual health educators, a core competency for nurses working with families in communities and across all health care delivery settings.
Perspectives on sexual and reproductive health, 2015
HIV disproportionately affects homeless youth, and interventions to date have had minimal success... more HIV disproportionately affects homeless youth, and interventions to date have had minimal success in reducing sexual risk behaviors in this population. Few qualitative studies have been conducted to provide insight into the influence of homelessness-related factors on sexual risk behaviors. A qualitative study with a quantitative component was conducted with a nonprobability sample of 64 homeless youth aged 14-24; participants were recruited from a variety of venues in Houston between October 2013 and March 2014. Thirteen focus group discussions were conducted; thematic analysis was used to identify themes related to HIV risk. Participants were predominantly black (75%), sheltered (67%) and aged 18 or older (77%). Youth discussed how the circumstances of their homelessness and the struggle to meet their immediate needs led to behaviors and experiences that put them at risk for HIV. Three themes emerged: Homeless youth frequently engage in risky sexual behavior, sometimes as a way to...
Although parental communication is effective in reducing adolescent risk behaviors, many parents ... more Although parental communication is effective in reducing adolescent risk behaviors, many parents hesitate to communicate with their children about sex. Community educators can be effective mediators to provide necessary information and skills to parenting adults. Each trained educator can reach many parenting adults producing an exponential effect on sexual health education and communication. Methods: The Building Family Connections (BFC) curriculum was developed to provide information and skills to increase parent-child sexual health communication. During a 2.5-day training, community educators are equipped to provide the 10-hour BFC curriculum to parenting adults in their communities. Objectives: To 1) evaluate the effectiveness of BFC curriculum training for educators, 2) assess uptake and utilization in educators' communities nationwide, and 3) evaluate effectiveness in transferring this information to parenting adults through trained community educators. Results: In May 200...
Background: Parents are important influences in the adolescent sexual decision-making. Even thoug... more Background: Parents are important influences in the adolescent sexual decision-making. Even though several programs aim to educate parents on sexual health communication with their children, there is not much information on retention and continued parent-child communication on sexual health issues. Furthermore, cultural barriers in Hispanics deter continued parent-child communication on sex. Methods: A Spanish-language curriculum, Construyendo Familias Unidas, showed improved knowledge and skills in Hispanic parents in border communities. Follow up data were obtained 12-24 months after the completion of curriculum classes to assess retention of knowledge and skills as well as communication frequency and behaviors. Objectives: The follow up assessment objectives were to 1) test retention of parent knowledge of risk factors for sexually transmitted infections (STIs) and teen pregnancy and 2) assess frequency and behaviors of parenting adult-child communication on sexual health issues....
Background: Parents are important influences in the adolescent sexual decision-making. However, b... more Background: Parents are important influences in the adolescent sexual decision-making. However, barriers such as embarrassment, lack of information, and sensitive topic deter parent-child communication on sex. Two Hispanic economically disadvantaged border communities in Texas with ~20,000 residents are disproportionately affected by outcomes such as teen pregnancies and sexually transmitted infections (STIs). To enhance prevention efforts, it is important to equip Hispanic parents with the tools to communicate with their children about sexual health topics. Methods: A Spanish-language curriculum, Construyendo Familias Unidas, was provided to parenting adults in two border communities in Texas. Participants received 10 hours of training on sexually transmitted infections (STIs), teen pregnancy, contraception, effective parent-child communication, and decision making. Changes in knowledge, attitudes and behaviors were assessed through pre-/post-survey data collected from 2007 to 2009...
Rates of shelter use among homeless youth are low compared to use of other supportive services, y... more Rates of shelter use among homeless youth are low compared to use of other supportive services, yet research on barriers to shelter use has been conducted in limited regions, specifically in West Coast or Midwest cities. Additionally, while studies have generally focused on barriers to shelter use, studies on what might facilitate shelter use are lacking. This study explores barriers and facilitators to shelter use among homeless young adults from a large city in the Southwest region. Focus groups were conducted with a diverse sample of 49 homeless young adults ages 18-24. Drawing on models of health service use, findings were categorized into two domains - attitudinal and access. Themes related to attitudinal barriers include stigma/shame and self-reliance/pride. Attitudinal facilitators include the desire to extricate themselves from street life and turn their lives in a new direction. Access-related themes include barriers such as a lack of shelters and services available to meet the needs of youth, adverse shelter conditions, staff attitudes that are not acceptable to youth, restrictive shelter rules, restrictive definitions of homelessness, and a desire to differentiate themselves from older homeless individuals. Certain characteristics or circumstances (e.g., being pregnant), having supportive others, and shelters' ability to connect them to other services emerged as access facilitators to shelter use. Implications for policymakers, service providers, and future research are discussed.
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Papers by Diane Santa Maria