Early Adolescent Latinas and Non-Coital Sexual Behavior: Individual, Social, and Parental Variables

Unplanned pregnancies and sexually transmitted infections (STI) are increasing at a faster rate among young, low income Latinas as compared to other low income groups of girls. However, little is known about the non-coital behavior that early adolescent girls may engage in, which puts them at risk for initiation of intercourse. This study examines the frequency of a particular non-coital behavior, being touched below the waist on top of clothes, and investigates how girls who engage in this behavior differ from those who do not with respect to individual (biologic and cognitive), social (peer norms and acculturation), and parental (single versus dual parent home) variables. Forty-four English-speaking Latinas completed an electronic survey assessing demographic and key study variables. The survey was conducted in a middle school computer lab before and after school, under adult supervision, as part of a larger study testing a pregnancy prevention program. Almost one third of the sample (31.8%) reported being touched below the waist with their clothes on. Those who reported this behavior differed from those who did not with respect to one individual (sexual agency) and one social variable (peer norms) (p \u3c .05). Study findings indicate that early adolescent Latinas are engaging in non-coital behavior that put them at risk for initiating intercourse. These findings argue for the power of peer norms in this age group

Influence of nighttime interruptions on sleep and function of patients following traumatic brain injury

Thesis (Ph.D.)--University of Washington, 2017-06In the United States, nearly 282,000 people are hospitalized for traumatic brain injury (TBI) each year. TBI includes patients with moderate and severe TBI. As a part of the clinical care continuum, intermediate care is traditionally the last stage of inpatient hospitalization for people with TBI cases in U.S. facilities. There, an interdisciplinary team evaluates a patient’s recovery from brain injury to identify appropriate care referral which is usually a skilled nursing facility, inpatient rehabilitation, or home. Unfortunately, while hospitalized the patient with TBI may encounter a care environment that is not always supportive of recovery. The environment of care is often a barrier and a facilitator to post-TBI recovery, because it influences important physiologic processes, notably sleep. It is a barrier because when there are excessive stimuli there is less rest. It is a facilitator because when these stimuli are curbed, there is a therapeutic effect that takes place. Overall, the goal in the intermediate care environment is to minimize barriers and augment facilitators of health improvement. In patients with TBI, both factors of intrinsic and extrinsic origin contribute to sleep disturbance and act as barriers. Among hospitalized patients of all kinds, extrinsic factors like hospital noise, exposure to light, and nighttime awakenings (either caused by hospital staff or occurring naturally in the patients themselves) are noted as salient barriers. These same problems can be assumed to also burden hospitalized patients with TBI. However the available literature on sleep disturbance of patients with TBI housed on intermediate care units is sparse. Current methods to describe the influence of the care environment on the sleep health of this patient population are also sparse. This may be due in part to the short and unpredictable length of stay for these patients when they are housed in intermediate care units—a phase of hospitalization where they are monitored until they are medically stable enough to be transferred to another level of care. Another challenge relates to conducting clinical research on a vulnerable population because it which requires more resources to obtain informed consent (support from legally authorized representative [LAR]). There is also the challenge of assessing sleep variables among a population with accompanying injuries and co-morbidities. Even if a retrospective study is implemented, there is the challenge of securing pertinent and consistent sleep and environmental information from the electronic medical record (EMR). More importantly, the challenge of not knowing the pattern of environmental and sleep characteristics of this group can prevent a nurse researcher from knowing what type of environmental curbing to focus on. For these reasons, the dual approach of documenting both sleep actigraphy and continuous external stimuli in the patient’s room may be necessary for the development of pertinent care interventions. The dissertation is composed of three manuscripts. The first manuscript aims to describe the utility of the EMR in identifying sleep health in patients with moderate-to-severe TBI who are housed in the neuroscience intermediate care setting. The second manuscript focuses on the methods for describing objective rest/activity characteristics during nighttime hours (using actigraphy) for hospitalized patients with moderate-to-severe TBI. The third manuscript describes the utility of continuously logging select external stimuli in the hospital rooms of patients being treated for a moderate-to-severe TBI. The first manuscript is a retrospective chart review that describes documented nursing interventions and sleep health of patients with moderate-to-severe TBI (N= 34) housed in a neuroscience specialty unit of a level 1 trauma center during nighttime hours (2200 through 0800 hours). Subjects were identified from the trauma registry between January and March 2013. Data were extracted from both the trauma registry and the EMR. The variables of “mean nighttime care activities” and “slept well” were created based on nursing flow sheet logs and hospital notes during the nighttime hours for these patients for up to seven days. The results of the study show that while nightly nursing care activities are frequent (M = 5.6 activities per night), sleep/rest was poorly captured in nursing documentation. The paper highlights the absence of standard sleep/rest queries for nursing documentation in the EMR. The second manuscript recounts actigraphy findings from a single-cohort feasibility study (N = 17) and specifically details the sleep parameters of patients with moderate or severe TBI who are hospitalized on a neuroscience specialty floor of a level 1 trauma center. This manuscript also discusses some of the challenges of conducting actigraphy on this population as well as the underlying methodology and data analysis scheme. Wrist actigraphy data were collected on subjects for five consecutive days or until discharge from the unit; only nighttime sleep was analyzed. Injury and disability variables like Glasgow coma scale (GCS) and functional independence measure (FIM®), respectively, were also collected. Results from this study show that more than half the sample has sleep efficiencies of less than 80%. During the hours of sleep, the average number of wake bouts across the sample is frequent (M = 41 per person) and total wake time during the nighttime hours is excessive (M = 74 minutes), suggesting poor sleep consolidation in this group. Likely due to the small sample size, weak associations were found between the sleep parameters and primary injury/disability variables. The third manuscript recounts findings from a single-cohort feasibility study (N = 18) that sought to describe the pattern of ambient environmental influences on the sleep of a patient with moderate or severe TBI during the nighttime hours of hospitalization on an intermediate care neuroscience specialty unit (2000 to 0800 hours). For up to five days or until discharge from the unit, wrist actigraphy and a custom, multi-sensor device continuously logged sleep-wake cycles and ambient stimuli, respectively, of a patient housed on the unit. The manuscript results show that sound and motion signaling significantly influences the probability of nighttime awakenings for patients in the sample. During nighttime hours, mean sound levels were 52 decibels (A-weighted); mean light levels were 9 lumens, and the mean proportion of movement was 0.28 (p) (28%). With the ambient stimuli set at their mean levels, there is a 20% probability that patients will wake during the night (multi-level logistic regression).The comprehensive results from these papers suggest that implementation of known (actigraphy) and novel (multi-sensor) technologies among this patient population could yield critical information about the pattern of sleep and the pattern of environmental stimuli

Adapting Cognitive Interviewing For Early Adolescent Hispanic Girls And Sensitive Topics

Cognitive interviewing is a research technique commonly used in survey research to improve measurement validity. However, this technique is useful to researchers planning to use self-report measures in intervention research because invalidity of such measures jeopardizes detection of intervention effects. Little research currently exists regarding the use of cognitive interviewing techniques with adolescent populations, particularly those who are Hispanic. This article describes common challenges to conducting cognitive interviewing with early adolescent girls and how these challenges are impacted by Hispanic culture and sensitive topics. A focus group approach is recommended over the traditional one-on-one cognitive interview format, and experiences from actual focus groups conducted in preparation for an intervention study are used to illustrate strategies for accomplishing the goals of cognitive interviewing. Creative and careful planning, attention to developmental considerations, and incorporation of cultural values are essential to the success of this approach

Adapting Cognitive Interviewing for Early Adolescent Hispanic Girls and Sensitive Topics

Cognitive interviewing is a research technique commonly used in survey research to improve measurement validity. However, this technique is useful to researchers planning to use self-report measures in intervention research because invalidity of such measures jeopardizes detection of intervention effects. Little research currently exists regarding the use of cognitive interviewing techniques with adolescent populations, particularly those who are Hispanic. This article describes common challenges to conducting cognitive interviewing with early adolescent girls and how these challenges are impacted by Hispanic culture and sensitive topics. A focus group approach is recommended over the traditional one-on-one cognitive interview format, and experiences from actual focus groups, conducted in preparation for an intervention study are used to illustrate strategies for accomplishing the goals of cognitive interviewing. Creative and careful planning, attention to developmental considerations, and incorporation of cultural values are essential to the success of this approach

Examining Age-Related Differences in Functional Domain Impairment Following Traumatic Brain Injury

Objective To examine differences in the functional recovery trajectories between younger and older adults with mild–moderate traumatic brain injury (TBI) in the first year postinjury as well as health-related quality of life. Design Observational cohort. Setting Level one trauma centre in the State of Washington. Participants Adults with mild–moderate TBI (N = 34; younger adults, n = 19, and older adults, n = 15). Interventions None. Main Outcome Measures Functional Status Examination (FSE) and health-related quality of life (HRQOL; SF-12v2). Results Older adults consistently showed significantly worse functional performance than younger adults following TBI in the following FSE domains: mobility, ability to travel, home maintenance and overall functional status. For both groups, preinjury physical health was significantly correlated with ability to travel and social integration at 12-month postinjury. Older participants’ preinjury physical and mental health had significant and negative correlation with their functional status. Conclusions Our study provides insights and implications into adults’ specific functional impairments following TBI, and which domains have persistent deficits. Implications for Practice Early intervention and rehabilitation should focus on improving older adults’ physical functioning and mobility. Our study may also inform future research and design of post-TBI interventions for older adults

Ambient Stimuli Perpetuate Nighttime Sleep Disturbances in Hospital Patients With TBI

Background and Objectives: The effect of the ambient environment, sound, light, and movement, on the nighttime rest-activity of patients hospitalized with moderate-severe traumatic brain injury (TBI) is poorly understood. The purpose of this study was to examine how sound, light, and movement in these patients' hospital rooms may contribute to nighttime awakenings. Methods: An observational design was used with 18 adult participants on a neuroscience step-down unit diagnosed with moderate-severe TBI. For up to five consecutive nights, actigraphy was used to capture nighttime awakenings while a custom-made multisensory device captured sound, light, and movement exposures in the participant's room. Results: Participants were awake for 24% (or about 3 hr) of the time during the designated nighttime period of 8 pm to 8 am. Average nighttime exposures of sound was 52 dB, light was nine lumens, and movement, measured as a proportion, was 0.28% or 28%. With each stimuli exposure set at its average, there was a 20% probability of participant nighttime awakenings. Clinically meaningful reductions of movement in and out the participant's room and elevated sound significantly decreases the participant's probability of nighttime awakenings (p < .05), but reductions in light did not. Conclusion: The ambient environment seems to impede restful sleep in immediate post-injury phase of patients with moderate-severe TBI

Interaction of obstructive sleep apnea severity and amyloid burden on novel plasma biomarkers of tau and neurofilament light protein in community‐dwelling cognitively normal older‐adults

Background Recent evidence suggest that plasma Tau and neurofilament light (NfL) have high potential as markers of neurodegeneration in Alzheimer disease (AD). Obstructive sleep apnea (OSA) severity increases AD risk and is associated with well‐validated markers of AD pathology in cognitively normal older‐adults. We determined the independent and combined effects of OSA severity and amyloid burden on plasma levels of Tau, and NfL, in community‐dwelling cognitively normal older‐adults. Method Cross‐sectional analysis of baseline data from 70 community‐dwelling cognitively normal older‐adults, selected from ongoing NYU prospective longitudinal studies on memory, sleep and aging. CSF‐Aβ42 (measured using ELISA) quantified amyloid burden. OSA severity was defined using AHI4%. Levels of plasma Tau and NfL were determined using single molecule array (SIMOA) technology ultra‐sensitive assays. Associations of OSA severity and plasma Tau and NfL were assessed using Pearson correlation analysis. The interactive associations of OSA severity and CSF‐Aβ42 levels on plasma Tau and NfL was assessed using generalized linear models. Analyses were adjusted for age, sex, BMI, education and APOE4. Result Of the 70 participants, 42 (60%) were women. Mean (SD) age was 68.7 (7.1) years. Mean (SD) AHI was 11.4/hr. (13.7) {29 (40%) had AHI 30}. Independent of CSF‐Aβ42, OSA severity was not associated with plasma Tau (r=.11, p‐value=.38), or plasma NfL (r=.05, p‐value=.67). The interactive associations of OSA severity and CSF‐Aβ42 levels on plasma Tau (β =0.042; 95% CI, 0.013 to 0.070) and NfL (β = 0.055; 95% CI, 0.022 to 0.089) were significant, P < .05 for all. The analysis was not powered for generating dichotomized strata specific (i.e. OSA+/Aβ+, OSA+/Aβ‐, OSA‐/Aβ+ and OSA‐/Aβ‐) estimates. Conclusion In this sample of cognitively normal older‐adults, OSA severity was not associated with plasma levels of Tau and NfL. However, β estimates of the interactive associations of OSA severity and CSF‐Aβ42 levels suggest that their combined effect is associated with higher plasma levels of Tau or NfL. Larger cohorts are necessary to delineate mechanisms and examine for OSA/Aβ strata‐specific estimates

Sleep Health among Racial/Ethnic groups and Strategies to achieve Sleep Health Equity

This book chapter describes the prevalence, burden, and causes of poor sleep health (duration, sleep disorders, efficiency, sleep quality, sleepiness/alertness, and timing/chronotype) patterns among racial and ethnic minorities. Disparities of sleep health exist across racial/ethnic groups, as Blacks, Latina/os, Asians, and Native Hawaiian and Pacific Islanders have a high burden of insufficient sleep, sleep deprivation, and poor sleep quality. Meanwhile, Asians and native Hawaiian and Pacific Islanders consistently report greater sleep complaints, and Blacks report greater levels of sleepiness compared to other groups. Poor sleep health can be attributed to a variety of causes, including biological (circadian rhythm), behavioral (diet and exercise), psychosocial factors (stress, mental health, poverty, social demands), and environmental factors (noise and light), which we describe in detail. Lastly, this chapter describes how the burden of poor sleep health among racial/ethnic groups is linked to adverse health outcomes, such as cardiovascular disease (CVD), diabetes, and mental health problems. At the end, evidence-based ideas for policies, action, and research agenda were presented to walk the talk of sleep health equity

Age-associated differences in sleep duration in the US population: potential effects of disease burden

Objectives: We contrasted the relative risks (RR) of short [8 h] sleep experienced by middle-aged (45-64 years) and older (>65 years) adults, compared with young adults (20-44 years). Methods: We utilized NHANES data (2005-2016), capturing sociodemographic, socioeconomic, and health-related data among US adults. Results: The Relative Risk (RR) of short sleep between young and middle-aged adults did not differ [RR = 1.02, NS]. However, the RR of short sleep was significantly reduced among older participants [RR = 0.81, p < 0.01]. Middle-aged adults had significantly lower RR of long sleep [RR = 0.80, p < 0.01], whereas older adults had significantly greater RR of long sleep [RR = 1.41, p < 0.01]. Compared with young adults, older adults with or without increased disease burden had significantly lower RR of short sleep [RR = 0.81, p < 0.01 and RR = 0.80, p < 0.01], respectively. However, for middle-aged adults, the RR of short sleep did not differ whether they reported a greater disease burden. Relative to young adults, older adults with or without disease burden had higher RRs of long sleep [RR = 1.39, p < 0.01] and [RR = 1.45, p < 0.01], respectively. For middle-aged adults without disease burden, the RR of long sleep was lower than among young adults [RR = 0.72, p < 0.01]. Conclusions: Compared with young adults, older adults were not at increased risk for short sleep. Rather, they reported longer sleep time regardless of the presence of disease burden. Future studies should investigate longitudinal effects of aging on objective sleep time, with or without common diseases. (c) 2021 Elsevier B.V. All rights reserved

791 Association of Obstructive Sleep Apnea Severity and Novel Plasma Biomarkers of Alzheimer’s Disease Pathology

Abstract Introduction Recent evidence suggests novel plasma Alzheimer’s Disease (AD) pathology biomarkers have high potential for AD risk prediction. We determined whether obstructive sleep apnea (OSA) severity is associated with plasma levels of Aβ40, Aβ42, Aβ42/Aβ40, Tau, tau/Aβ42 and NfL and whether this relationship is dependent of amyloid burden. Methods Cross-sectional analysis of baseline data from 120 community-dwelling, cognitively normal older-adults, selected from ongoing NYU prospective longitudinal studies on memory, sleep and aging. Of the 120 participants, 70 had baseline CSF-Aβ42 (measured using ELISA). OSA-severity was defined using AHI4% criteria. Levels of plasma Aβ40, Aβ42, Tau and NfL were determined using single molecule array technology ultra-sensitive assays. Associations of OSA-severity and plasma AD-biomarker levels (n=120) were assessed using Pearson correlation analysis. The association of OSA-severity and AD plasma biomarkers dependent on CSF-Aβ42 levels (n=70) was assessed using generalized linear models. Analyses were adjusted for age, sex, BMI, race, education and APOE4. Results Of the 120 participants, 80 (67%) were women. Mean (SD) age was 69.1 (7.2) years. Mean (SD) AHI was 14.3/hr. (16.3) {48 (40%) had AHI 30}. Independent of amyloid-burden, OSA-severity was associated with higher levels of plasma Aβ40 (r=.21, p-value=.02), plasma Aβ42 (r=.26, p-value=.01), plasma Aβ42/Aβ40 (r=.20, p-value=.05), but not plasma Tau, plasma tau/Aβ42 or plasma NfL. The association of OSA-severity and plasma levels of Tau, Tau/Aβ42 or NfL dependent on CSF-Aβ42 levels revealed significant interactions between CSF-Aβ42 levels and AHI (p-value <.05 for all), with β-estimates suggesting that with combined increases in AHI and decreases in CSF-Aβ42 levels, there were corresponding increases in plasma levels of Tau, plasma Tau/Aβ42 or plasma NfL. The analysis was not powered for generating dichotomized strata specific (i.e. OSA+/Aβ+, OSA+/Aβ-, OSA-/Aβ+ and OSA-/Aβ-) estimates. Conclusion In this sample of cognitively-normal older- adults, OSA-severity was associated with levels of plasma Aβ40, Aβ42, Aβ42/Aβ40 and showed a synergistic effect with CSF Aβ42 on plasma levels of tau and NfL. Larger cohorts are necessary to delineate mechanisms and examine for OSA/Aβ strata-specific estimates. Support (if any) NIH/NIA/NHLBI (L30-AG064670, CIRAD-P30AG059303-Pilot, NYU-ADRC-P30AG066512-Developmental-Grant, AASM#231-BS-20