A randomized controlled trial to improve health among women receiving welfare in the U.S.: The relationship between employment outcomes and the economic recession

The high prevalence of health conditions among U.S. women receiving Temporary Assistance for Needy Families (TANF, or `welfare') impedes the ability of many in this group to move from `welfare-to-work', and the economic recession has likely exacerbated this problem. Despite this, few interventions have been developed to improve employment outcomes by addressing the health needs of women receiving TANF, and little is known about the impact of economic downturns on the employment trajectory of this group. Using data from a recent randomized controlled trial (RCT) that tested the efficacy of a public health nursing (PHN) intervention to address the chronic health condition needs of 432 American women receiving TANF, we examine the effect of the intervention and of recession exposure on employment. We further explore whether intervention effects were modified by select sociodemographic and health characteristics. Both marginal and more robust intervention effects were noted for employment-entry outcomes (any employment, p=0.05 and time-to-employment, p=0.01). There were significant effects for recession exposure on employment-entry (any employment, p=0.002 and time-to-employment, p<0.001). Neither the intervention nor recession exposure influenced longer-term employment outcomes (employment rate or maximum continuous employment). Intervention effects were not modified by age, education, prior TANF receipt, functional status, or recession exposure, suggesting the intervention was equally effective in improving employment-entry across a fairly heterogeneous group both before and after the recession onset. These findings advance our understanding of the health and employment dynamics among this group of disadvantaged women under variable macroeconomic conditions, and have implications for guiding health and TANF-related policy

Headache and Health-Related Job Loss Among Disadvantaged Women

AbstractHeadache is a significant public health issue and a major cause of work-related disability. Given that lower-income groups suffer more frequent and more severe headaches, this study examined the associations between headaches, comorbid conditions, symptom management, and health-related job loss in 432 low-income women. The presence of headaches, headaches and allergy symptoms combined, and a higher number of comorbid conditions were significantly associated with health-related job loss. Medication use and emergency department use patterns suggest further research related to day-to-day headache symptom management strategies, and role functioning among this vulnerable group is needed

Nurse scientists overcoming challenges to lead transdisciplinary research teams

Increasingly, scientific funding agencies are requiring that researchers move toward an integrated, transdisciplinary team science paradigm. While the barriers to and rewards of conducting this type of research have been discussed in the literature, examples of how nurse investigators have led these teams to reconcile the differences in theoretical, methodological, and/or analytic perspectives that inevitably exist are lacking. In this article, we describe these developmental trajectory challenges through a case study of one transdisciplinary team, focusing on team member characteristics and the leadership tasks associated with successful transdisciplinary science teams in the literature. Specifically, we describe how overcoming these challenges has been essential to examining the complex, and potentially cumulative effects that key intersections between legal, social welfare, and labor market systems may have on the health of disadvantaged women. Finally, we discuss this difficult, but rewarding work within the context of lessons learned and transdisciplinary team research in relation to the future of nursing science

Synthesizing Marketing, Community Engagement, and Systems Science Approaches for Advancing Translational Research

The adoption and implementation of evidence-based interventions (EBIs) are end goals of translational research, however, potential end-users’ perceptions of an EBI’s value have contributed to low rates of adoption. In this article, we describe our application of emerging dissemination and implementation science theoretical perspectives, community engagement, and systems science principles to develop a novel EBI dissemination approach. Using consumer-driven, graphics-rich simulation, the approach demonstrates predicted implementation effects on health and employment outcomes for socioeconomically disadvantaged women at the local level, and is designed to increase adoption interest of county program managers accountable for improving these outcomes in their communities

Depressive symptoms and cortisol variability prior to surgery for suspected endometrial cancer

Endometrial cancer (EC) is the most common type of gynecologic cancer affecting women; however, very little research has examined relationships between psychological factors and hypothalamic-pituitary-adrenal (HPA) axis dysregulation in this population. The current study examined relations between depressive/anxious symptoms and salivary cortisol diurnal rhythm and variability in women undergoing surgery for suspected endometrial cancer. Depressive and anxious symptoms were measured prior to surgery using the Structured Interview Guide for the Hamilton Depression Inventory (SIGH-AD). Saliva was collected four times a day for the three days prior to surgery and then assayed by ELISA to obtain cortisol concentrations. Cortisol slopes and intraindividual variability were then calculated across subjects. Relations between depressive/anxious symptoms and cortisol indices were examined using multilevel modeling and linear regression analyses. Participants were 82 women with nonmetastatic endometrial cancer. Anxious symptoms were not associated with either cortisol slope or intraindividual variability, and depressive symptoms were unrelated to cortisol slope. However, after controlling for presence of poorer prognosis cancer subtypes, greater depressive symptoms (excluding symptoms possibly/definitely due to health/treatment factors) in the week preceding surgery were significantly related to greater cortisol intraindividual variability (β=.214; p<.05). These results suggest that depressive symptoms prior to surgery for suspected endometrial cancer are related to greater cortisol intraindividual variability, which is suggestive of more erratic HPA axis arousal. Future research should examine whether mood symptoms may be associated with compromised health outcomes via erratic HPA axis arousal in this population

Bridging the gender divide: Facilitating the educational path for men in nursing

Background: Although the number of men entering the nursing profession over the past century has increased in-crementally, the proportion of men remains low in contrast to the U.S. population. On matriculation into nursing school, men face stereotypes about the nursing profession and the characteristics of the men who enter it. Men may also face a number of gender-based barriers, including lack of history about men in nursing, lack of role models, role strain, gender discrimination, and isolation. Method: This article describes each of these barriers and provides strategies to improve male students’ learning experience. Results: The efforts of one nursing school to address many of these barriers are also described. Conclusion: Through acknowledging gender barriers and taking intentional steps to address them with prenursing and nursing students, schools of nursing may create a more inclusive environment and enhance the profession’s diversity

RWJF\u27s Future of Nursing\u27s Campaign for Action: A Content Analysis of Social Determinants of Health Activities

The RWJF-sponsored 2010 report, The Future of Nursing: Leading Change, Advancing Health (FoN), fostered creation of the Campaign for Action (Campaign) as a mechanism to monitor and enact the FoN report\u27s recommendations. Influenced by RWJF\u27s Culture of Health initiative, Campaign efforts refocused to include the social determinants of health (SDOH), with an additional action area entitled “Building Healthier Communities” (BHC). This study describes nursing activities in the BHC action area relative to the six initial FoN core action areas and assesses the extent to which nursing actions in the BHC action area align with public health conceptions of the SDOH. A content analysis was conducted of the RWJF\u27s Campaign issue blog posts on 51 state Action Coalition websites from January 2011 to August 2018. Results demonstrate a decline in blog posts among the six FoN action areas over time compared to an increase in the BHC action area. BHC blog posts of nursing activities included predominantly stories and events, with few interventions. Although the Campaign\u27s definition of the SDOH aligns with definitions from public health, posted actions do not. Re-evaluation of the Campaign\u27 tagging process is needed so system-level conceptualizations can be integrated into the Campaign\u27s next iteration for categorizing SDOH-driven interventions

Comparison of Depressive Symptom Severity Scores in Low-Income Women

BACKGROUND: The Beck Depression Inventory, Second Edition (BDI-II), and the Patient Health Questionnaire-9 (PHQ-9) are considered reliable and valid for measuring depressive symptom severity and screening for a depressive disorder. Few studies have examined the convergent or divergent validity of these two measures, and none has been conducted among low-income women-although rates of depression in this group are extremely high. Moreover, variation in within-subject scores suggests that these measures may be less comparable in select subgroups. OBJECTIVE: We sought to compare these two measures in terms of construct validity and to examine whether within-subject differences in depressive symptom severity scores could be accounted for by select characteristics in low-income women. METHODS: In a sample of 308 low-income women, construct validity was assessed using a multitrait-monomethod matrix approach, between-instrument differences in continuous symptom severity scores were regressed on select characteristics using backward stepwise selection, and differences in depressive symptom classification were assessed using the Mantel-Haenszel test. RESULTS: Convergent validity was high (rs = .80, p \u3c .001). Among predictors that included age, race, education, number of chronic health conditions, history of depression, perceived stress, anxiety, and/or the number of generalized symptoms, none explained within-subject differences in depressive symptom scores between the BDI-II and the PHQ-9 (p \u3e .05, R2 \u3c .04). Similarly, there was consistency in depressive symptom classification (χ = 172 and 172.6, p \u3c .0001). DISCUSSION: These findings demonstrate that the BDI-II and the PHQ-9 perform similarly among low-income women in terms of depressive symptom severity measurement and classifying levels of depressive symptoms, and do not vary across subgroups on the basis of select demographics