HIV pre‐exposure prophylaxis uptake by advanced practice nurses: Interplay of agency, community and attitudinal factors

Aims To identify associations among agency, community, personal and attitudinal factors that affect advanced practice nurses’ uptake of HIV pre‐exposure prophylaxis, an intervention consists of emtricitabine/tenofovir once‐daily pill, along with sexual risk reduction education. Design Cross‐sectional. Methods During March‐May 2017, randomly selected Indiana advanced practice nurses were invited to complete an online survey, consisted of several validated self‐rating measures (N = 1,358; response = 32.3%). Final sample (N = 369) was predominantly White, non‐Hispanic, female advanced practice nurses in urban practices (mean age = 46). Conceptual model for structural equation model included 29 original/composite variables and five latent factors. Results Final model consisted of 11 variables and four factors: agency, community, HIV prevention practices (including screening) and motivation to adopt evidence‐based practices overall. Community had direct effects on HIV prevention practices (estimate = 0.28) and agency (estimate = 0.29). Agency had direct effects on HIV prevention practices (estimate = 0.74) and motivation to adopt evidence‐based practices (estimate = 0.24). Community had indirect effects, through agency, on the two remaining factors. Conclusion Barriers exist against pre‐exposure prophylaxis implementation, although practice guidelines are available. HIV prevention practices must be integrated across organizational structures, especially in high‐risk communities, whereas practice change is more effective when focused on changing providers’ attitudes towards intervention. When planning a pre‐exposure prophylaxis intervention, advancing inputs from healthcare professionals, organizational leadership and community members, is crucial to success. Impact In settings where advanced practice nurses are primary contact points for health care, they may be best positioned to have an impact on implementation of HIV risk reduction strategies. Further research is needed to optimize their contributions to pre‐exposure prophylaxis implementation

Mammography Social Support for Women Living in a Midwestern City: Toward Screening Promotion via Social Interactions

Notwithstanding recommendations and interventions, the percentage of 50 – 74-year-old U.S. women who reported having had a mammography in the past two years remained below target coverage. Social interactions may influence mammography rates. To measure characteristics of social interactions in a Midwestern city as they relate to social support for mammography received by women older than 40 years of age. A cross-sectional study was conducted in Bloomington, Indiana, sending mail surveys to 3,000 telephone directory addresses selected by simple random sampling. An anonymous, self-administered, closed-ended, questionnaire with eight checklist items (for demographics) and six multipart semantic differential scale items (for social support), derived from validated instruments, was used. Social support for mammography in women who had undergone regular screening was analyzed using chi-square test and logistic regression. Of 450 respondents with valid responses, 91% were white; 47% were older than 80; 92% had good health insurance coverage; and 82% had undergone regular mammography. Healthcare workers provided the highest support, followed by children, siblings, and relatives. Friends, neighbors, and co-workers were least supportive. In social interactions, emotional support was the most prominent, followed by informational, appraisal, and instrumental supports. Having higher income and being married were associated with receiving greater support. Although mammography provides limited benefits after age 74, women older than 80 years of age received the highest support. Identifying the structural and functional characteristics of social interactions is important for: 1) designing interventions that enhance social support, and 2) expanding breast cancer screening via personalized approaches using existing social interactions

Global Perspectives for Strengthening Health Education: A Mixed-Methods Study

This study aimed to identify the knowledge, experiences, and attitudes about current practices of health education (HE) among government-affiliated high-profile health administrators in developed and developing nations. Respondents (N = 21) were purposively selected based on their affiliation as a health administrator at the national level, with roles in high-profile decision-making for devising policies/programs and allocating funding or advocating strategies to advance HE. Information was gathered using a web-based cross-sectional survey in 5 languages, consisting of 14 closed-ended and 8 open-ended questions. A majority were males (70%) and spoke English (57%), 45% had postgraduate degrees, and 57% were from high-income countries. Participants recognized the importance of HE in their countries and estimated percentages of adults who received health information through various sources. Participants also rated population subgroups that benefit from HE. They highly rated these health issues for HE: control/prevention of communicable diseases, nutrition, physical activity, mental health, and tobacco and other drugs. Only 40% reported having enough resources and funding available for HE. For the qualitative questions, irrespective of being from developed or developing countries, most respondents identified the need for invigorating HE that could be categorized into seven key areas: HE program evaluation, actions to strengthen HE, organizations responsible for identifying HE priorities, job titles of health educators, how ministry collects information on HE needs, high priority health issues and ensuring equity, and ways nongovernmental organizations can strengthen HE. Findings were helpful to identify: high priority HE issues across countries; status of HE programs among government entities; status of funding for HE programs; and how countries can provide more effective program outcomes. Further studies with higher response rate are needed to address these specific issues

Effects of ACT Out! Social Issue Theater on Social-Emotional Competence and Bullying in Youth and Adolescents: Cluster Randomized Controlled Trial

Background: Schools increasingly prioritize social-emotional competence and bullying and cyberbullying prevention, so the development of novel, low-cost, and high-yield programs addressing these topics is important. Further, rigorous assessment of interventions prior to widespread dissemination is crucial. Objective: This study assesses the effectiveness and implementation fidelity of the ACT Out! Social Issue Theater program, a 1-hour psychodramatic intervention by professional actors; it also measures students' receptiveness to the intervention. Methods: This study is a 2-arm cluster randomized control trial with 1:1 allocation that randomized either to the ACT Out! intervention or control (treatment as usual) at the classroom level (n=76 classrooms in 12 schools across 5 counties in Indiana, comprised of 1571 students at pretest in fourth, seventh, and tenth grades). The primary outcomes were self-reported social-emotional competence, bullying perpetration, and bullying victimization; the secondary outcomes were receptiveness to the intervention, implementation fidelity (independent observer observation), and prespecified subanalyses of social-emotional competence for seventh- and tenth-grade students. All outcomes were collected at baseline and 2-week posttest, with planned 3-months posttest data collection prevented due to the COVID-19 pandemic. Results: Intervention fidelity was uniformly excellent (>96% adherence), and students were highly receptive to the program. However, trial results did not support the hypothesis that the intervention would increase participants' social-emotional competence. The intervention's impact on bullying was complicated to interpret and included some evidence of small interaction effects (reduced cyberbullying victimization and increased physical bullying perpetration). Additionally, pooled within-group reductions were also observed and discussed but were not appropriate for causal attribution. Conclusions: This study found no superiority for a 1-hour ACT Out! intervention compared to treatment as usual for social-emotional competence or offline bullying, but some evidence of a small effect for cyberbullying. On the basis of these results and the within-group effects, as a next step, we encourage research into whether the ACT Out! intervention may engender a bystander effect not amenable to randomization by classroom. Therefore, we recommend a larger trial of the ACT Out! intervention that focuses specifically on cyberbullying, measures bystander behavior, is randomized by school, and is controlled for extant bullying prevention efforts at each school.Funding for this study was provided by Lilly Endowment Inc, grant no. 2019 0543, to Claude McNeal Productions. Funding was provided to Prevention Insights via a subaward from that grant. Claude McNeal Productions and their representatives own the rights to the ACT Out! Social Issue Theater program. No one from that organization was involved in preparing the study protocol, interpreting findings, conducting analyses, or writing this manuscript, both as a matter of practice and per written agreement in the subaward to Prevention Insights

Arm Circumference-to-Height Ratio as a Situational Alternative to BMI Percentile in Assessing Obesity and Cardiometabolic Risk in Adolescents

Objective. To determine whether arm circumference-to-height ratio (AHtR) predicts adolescents’ cardiometabolic risk and how its predictive statistics compare to those of body mass index (BMI) percentile. Methods. Pooled data for adolescents (N = 12,269, 12–18 years) from the National Health and Nutrition Examination Survey, U.S., 1999–2014, were analyzed. For each of the eight cardiometabolic variables, borderline-risk and high-risk were considered unhealthy, and being unhealthy on any variable was considered “unhealthy overall” in terms of cardiometabolic risk. Area under the curve and R2 were used to compare BMI percentile and AHtR for accuracy in predicting risk. Results. Female AHtR ≥ 0.19 and BMI percentile ≥ 94 and male AHtR ≥ 0.16 and BMI percentile ≥ 64 predicted a probability of >0.7 being unhealthy overall. AHtR predicted overall risk and unhealthy levels of six variables more accurately than BMI percentile. Significant differences were overall risk (χ2 = 4.18; p=0.041), total cholesterol (χ2 = 8.68; p=0.003), glycated hemoglobin (χ2 = 5.24; p=0.022), and systolic pressure (χ2 = 5.10; p=0.024). AHtR had higher accuracy in predicting high-density cholesterol, fasting glucose, glycated hemoglobin, and systolic/diastolic pressures plus higher specificity in predicting all variables except triglycerides. BMI percentile had higher sensitivity for all variables. Sensitivity and accuracy were higher for males. No significant race/ethnicity differences were observed. Conclusions. Without needing adjustment for age and weight, AHtR can predict some cardiometabolic risk factors of adolescents, especially of males, more accurately than BMI percentile, thus facilitating population risk estimation and early interventions. Further research is required to validate these findings in younger children

Arm Circumference-to-Height Ratio as a Situational Alternative to BMI Percentile in Assessing Obesity and Cardiometabolic Risk in Adolescents

Objective To determine whether arm circumference-to-height ratio (AHtR) predicts adolescents' cardiometabolic risk and how its predictive statistics compare to those of body mass index (BMI) percentile. Methods Pooled data for adolescents ($N$ = 12,269, 12–18 years) from the National Health and Nutrition Examination Survey, U.S., 1999–2014, were analyzed. For each of the eight cardiometabolic variables, borderline-risk and high-risk were considered unhealthy, and being unhealthy on any variable was considered “unhealthy overall” in terms of cardiometabolic risk. Area under the curve and $R^2$ were used to compare BMI percentile and AHtR for accuracy in predicting risk. Results Female AHtR ≥ 0.19 and BMI percentile ≥ 94 and male AHtR ≥ 0.16 and BMI percentile ≥ 64 predicted a probability of >0.7 being unhealthy overall. AHtR predicted overall risk and unhealthy levels of six variables more accurately than BMI percentile. Significant differences were overall risk ($x^2$ = 4.18; $p$=0.041), total cholesterol ($x^2$ = 8.68; p=0.003), glycated hemoglobin ($x^2$ = 5.24; p=0.022), and systolic pressure ($x^2$ = 5.10; p=0.024). AHtR had higher accuracy in predicting high-density cholesterol, fasting glucose, glycated hemoglobin, and systolic/diastolic pressures plus higher specificity in predicting all variables except triglycerides. BMI percentile had higher sensitivity for all variables. Sensitivity and accuracy were higher for males. No significant race/ethnicity differences were observed. Conclusions Without needing adjustment for age and weight, AHtR can predict some cardiometabolic risk factors of adolescents, especially of males, more accurately than BMI percentile, thus facilitating population risk estimation and early interventions. Further research is required to validate these findings in younger children