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Description
This study examined the influence of the traditional values held by Mexican heritage parents on the intention of their adolescent children to use drugs. Specifically, the study tested a mediation model in which the traditional cultural values of parents were hypothesized to influence adolescent drug use intentions indirectly by influencing ethnic identify and adolescent perceptions of parental injunctive norms against drug use. Parents reported on traditional cultural values and expectations for their child. Adolescents reported perceived reaction from parents if they used drugs (parental injunctive norms), ethnic identity, and their intention to use drugs in the future. Two direct effects were observed: parental values on expectations and parental injunctive norms on adolescent drug use intentions. Two paths were also moderated by the sex of the adolescent. The path from parent values to parent expectations was significantly stronger for adolescent girls than boys; the path from ethnic identity affirmation to drug intentions was protective for boys but not for girls. The negative relationship between perceived parental reaction and adolescent drug use intentions suggests that anti-drug norms communicated by parents had a protective influence and can deter youth from using drugs. The results of the current study did not support the hypothesized mediational model, but did provide additional support for the importance of parental influence on adolescents' plans and ideas about using alcohol, cigarettes, and marijuana. More research is necessary to examine the influence of culture and the mechanisms by which cultural values impact Mexican heritage adolescents' intentions to use drugs and subsequent use.
ContributorsGarvey, Meghan (Author) / Gonzales, Nancy A. (Thesis advisor) / Marsiglia, Flavio F. (Committee member) / Mackinnon, David P. (Committee member) / Arizona State University (Publisher)
Created2012
Description
This study examined an adverse effect of an adolescent group intervention. Group interventions represent one of the most economical, convenient, and common solution to adolescent behavior problems, although prior findings from program evaluation studies have suggested that these groups can unexpectedly increase the externalizing behaviors that they were designed to reduce or prevent. The current study used data from a longitudinal, randomized controlled trial of the Bridges to High School / Puentes a La Secundaria Program, a multicomponent prevention program designed to reduce risk during the middle school transition, which has demonstrated positive effects across an array of outcomes. Data were collected at the beginning of 7th grade, with follow-up data collected at the end of the 7th, 8th, 9th, and 12th grade from a sample of Mexican American adolescents and their mothers. Analyses evaluated long-term effects on externalizing outcomes, trajectories of externalizing behaviors across adolescence, and potential mediators of observed effects. Results showed that the adverse effect that was originally observed based on adolescent self-report of externalizing symptoms at 1-year posttest among youth with high pretest externalizing symptoms was not maintained over time and was not reflected in changes in adolescents' trajectories of externalizing behaviors. Moreover, neither of the peer mediators that theory suggests would explain adverse effects were found to mediate the relationship between intervention status and externalizing symptoms at 1-year posttest. Finally, only beneficial effects were found on externalizing symptoms based on mother report. Together, these findings suggest that the Bridges intervention did not adversely affect adolescent problem behaviors and that future studies should use caution when interpreting unexpected adverse effects.
ContributorsWong, Jessie Jong-Chee (Author) / Gonzales, Nancy A. (Thesis advisor) / West, Stephen G. (Thesis advisor) / Chassin, Laurie (Committee member) / Dishion, Thomas (Committee member) / Arizona State University (Publisher)
Created2015
Description
An alarming number of youth have mental health concerns, but of those who are diagnosed, only half receive treatment. Using Bandera's social cognitive theory, one can achieve behavioral changes through self-efficacy and control their actions by self-regulation. Mindfulness activities, when implemented early, can decrease stress, and improve well-being in youth.
Methods:
This project was implemented among students attending an alternative high school in Arizona. Nine students participated in four different mindfulness, hands-on activities during two classes- 1 hour each. Participants completed a pre and a post-test with the 10-item questionnaire Perceived Stress Scale (PSS), and a 3-question survey to evaluate the program at the end of the second week.
Results: Among the 9 participants (mean age = 16 SD=2.06), the stress levels were considered low to moderate in the pretest (mean=16.56) and the post-test (mean=15.89). Stress level scores were reduced after the education although the difference was not statistically significant. Furthermore, all participants agreed that the content and activities were appropriate, 88.9% agreed they had a "better understanding of how to reduce stress," and 77.8% stated their "knowledge of stress has improved."
Discussion/Conclusion:
This project aimed to help reduce vulnerable adolescents' stress level through mindfulness activities. Mental health education like this may help adolescents better manage stress and consequently promote their overall well-being. Future projects should recruit a larger sample and implement a longer time for larger and longer effects.
ContributorsQualman, Stephanie (Author) / Chen, Angela (Thesis advisor) / College of Nursing and Health Innovation (Contributor)
Created2023-05-10
Description
Mental health challenges are becoming a significant public health issue for adolescents/teenagers, and primary interventions have been focused on mental health education. Because adolescents spend most of their time in school, primary mental health interventions should be prioritized in this setting. A PICOT question was developed to determine if mental health literacy (MHL) in adolescents would improve while decreasing stigma and improving help-seeking behaviors after a program of enhanced mental health education. Partnering with a large Arizona suburban school district social work department, a teen Mental Health First Aid (tMHFA) pilot program was implemented for a class of nine (n = 9) adolescent students (aged 17-18 years) old during the school day. tMHFA was delivered in three 90-minute class days. Using the Mental Health Literacy questionnaire (MHLq), a pre and post-test design revealed a significant (p value=less than 0.05) increase in the students' MHL, help-seeking behaviors, and decreased stigma after delivery. This quality improvement project was IRB approved, and all human subjects' rights were protected. In conclusion, there is strong evidence that enhanced mental health programming, such as tMHFA, effectively educates adolescents about mental health challenges and, perhaps, could promote behavioral changes in future generations.
ContributorsJones, M. Christina (Author) / Schiller, Zita (Thesis advisor) / College of Nursing and Health Innovation (Contributor)
Created2023-05-15
Description
Background: Diabetes (DM) is a costly disease that negatively impacts patients and the healthcare system that requires complex and structured management. Literature has shown a gap in effective, structured diabetic education and management for providers and patients.
Objective: The purpose of this quality improvement project was to investigate the impact of how outreach, through a structured educational care plan, affects healthcare team experience, perception, and impact on their ability to communicate and comanage patients' chronic diabetes. Utilizing telemedicine as an alternative to the office visit healthcare model to address a gap in care by providing ongoing, structured diabetes education and management.
Methods: A small-scale study initially included ten participants, with five that completed the study. This included the Population Outreach Team (POT), one provider, and four auxiliary support staff. They were introduced to and utilized a care plan tool (CPT) to assist providers and auxiliary health team communication and education delivery to patients with DM. The theoretical and implementation framework that guided the study was based on the nudge theory, focused on altering habits and behavior, and the Model for Improvement supporting future alterations and improvement as identified. A CPT was designed based on HEDIS diabetes measures and the American Diabetic Association (ADA). Improvement was measured through nine question pre- and post-surveys with an additional four questions specific to the CPT use based on a modified RAND Likert scale patient satisfaction survey. A post-qualitative interview with the provider was conducted to gain further insight into CPT use and perception.
Results: A total of ten healthcare and auxiliary participants joined the study; of these, five completed it. The data, including the pre- and post-perception surveys, were collected over a 6-week study period with a post-implementation interview with one provider. Data analysis was captured through descriptive statistics. Pre-perception, M = 19.6 (SD. 4.04, 14 – 25). Post-perception, M = 7.60 (SD. 1.34, 6 – 9). CPT perception post, M = 14.4 (SD. 3.65, 10 – 18). A lower score indicated improvement. The interview identified the following barriers that impacted the CPT's success, including the patient-provider relationship, EHR "easability", patient readiness, and patient education barriers.
Conclusion: This small study indicated the positive impact structured, ongoing education provides to improve communication and comanage patients' with DM through the POT improved perception with CPT use. Barriers identified will assist with future implementations and other areas for improvement, which may increase success in the objective of this study and the delivery of healthcare for patients with DM. Future utilization of this intervention may be easily translated to other primary care environments. The intention is that successful DM management may lead to decreased medical management, complications, and financial strain.
ContributorsWilde, Daniella (Author) / Moffett, Carol (Thesis advisor) / College of Nursing and Health Innovation (Contributor)
Created2023-05-01
Description
Background: There is growing evidence that persistent exposure to the adverse effects of stressful work conditions, abuse, and re-traumatization without proper intervention leads to compassion fatigue (CF) and reduced compassion satisfaction (CS). Without appropriate intervention, the outcome of CF affects the patient, staff, and the organization. Despite proposed self-care measures, mental health (MH) workers continue to struggle with CF and lack the resources to combat the issue.
Objectives: Ongoing awareness on the implications of trauma and its impact on one's behavior, supports the use of Trauma-informed care (TIC) skills in creating a conducive work environment. This quality improvement project examines the efficacy of TIC education as an intervention for CF pre/post-one-hour education session among MH workers.
Methods: MH nurses (n=8) from diverse backgrounds in a Phoenix inpatient psychiatric hospital gave consent for the study. Participation was sought via flyers and entailed attending the one-hour education session, filling out a demographic, and pre/post-professional quality of life (ProQol) surveys. The ProQol standardized tool measures CF, CS, and burnout with reliability >0.70. Expected outcomes include a reduction in CF and an improvement in CS. Data analysis using intellectus software involved descriptive analysis and paired t-tests to compare outcomes.
Results: Pre/post data analysis was statistically significant, P = 0.003, which shows a reduction in CF and an improvement in CS.
Conclusion: TIC as an intervention for CF looks promising. MH nurses can manage their stress symptoms and that of their patients using TIC skills.
ContributorsOnyia, Nneka (Author) / Guthery, Ann (Thesis advisor) / College of Nursing and Health Innovation (Contributor)
Created2023-04-29
Description
Introduction: The objective of this study is to emphasize the significance of exclusive breastfeeding (EB) and investigate methods to encourage and sustain it within a hospital environment. Using the self-efficacy theory, the study seeks to improve the current support system for breastfeeding mothers and their families. Methods: The project was approved by the university IRB and facility IRB; guidelines were maintained. The project takes place in a non-profit organization in the southwestern United States. Education was conducted at a required staff meeting for Women and Infant Services (WIS) floor about supporting breastfeeding mothers. A pre- and post-education Breastfeeding Knowledge Scale (BKS) survey was performed, effectiveness was measured using a two-tailed t-test. The reliability of the BKS scale is 0.83 and the validity of the scale is reported to be strong. The hospital measures the EB rates of patients that are greater than 37 weeks gestation without need for neonatal intensive unit care and the mom requests to breastfeed. Results: The goal was 42% rate of EB in the first 48 hours after birth. After education the average rate of EB was 39.6%, lower than the goal but higher than the 33.7% rate before education. A two-tailed paired sample t-test (n=27) was used for BKS and the results were significant based on an alpha value; thus, showing significant knowledge gain. Conclusion: Consistent staff education improves breastfeeding support for moms in the hospital, leading to successful exclusive breastfeeding. This project benefits various settings, such as pediatric, postpartum, labor and delivery, and pediatric offices.
ContributorsHudson, Jennifer (Author) / Esperas, Amanda (Thesis advisor) / College of Nursing and Health Innovation (Contributor)
Created2023-04-26
Description
Introduction: Depression screening in the pediatric setting is a crucial part of the adolescent's examination. A standardized screening tool and protocol streamlines the process of assessing adolescents and minimizes the chances of serious mental health disorders going undetected and untreated. Evaluation of current evidence demonstrates the use of a standardized tool improves detection, diagnosis, and management of depression and other mental health illnesses.
Method: The Patient Health Questionnaire—modified for adolescents (PHQ9-A) was administered to all eligible adolescents, ages 12-18, during an annual well visit for a period of 6 weeks. Lewin's Change Theory guided a system change in the electronic health record, and the questionnaire results were documented and provided to the pediatric provider at the time of the appointment. A chart review was conducted to determine whether all eligible patients were administered the questionnaire and if a depression diagnosis or mental health referral had been made.
Results: Out of 76 eligible well visits, 65 (86%) patients completed the PHQ9-A. The average score was 5.29 (SD = 6.49) with a maximum score of 25. Out of those that completed screening, 11 (17%) had a positive PHQ9-A score resulting in 8 referrals to mental health services and 2 mental health diagnoses in the clinic.
ContributorsCoomer, Meagan (Author) / Rauton, Monica (Thesis advisor) / College of Nursing and Health Innovation (Contributor)
Created2023-04-27
Description
Adolescent substance use is a complex and significant public health concern that has received considerable attention among researchers and practitioners (Gray & Squeglia, 2018). The purpose of this dissertation was to examine factors associated with substance use intervention effects and to develop subgroups of risk factors for Mexican adolescents. This dissertation utilizes secondary data from a randomized controlled trial of the school-based substance use universal prevention program, keepin’ it REAL (kiR). The dissertation included two studies. Study 1: This study tested a model on the efficacy of the school-based substance use universal prevention program, keepin’ it REAL, among a sample of Mexican adolescents (N = 3,742, 11-17 years old). Study 1 analysis included Structural Equation Modeling and results demonstrated that participation in kiR positively predicted alcohol resistance strategies and those alcohol resistance strategies were negatively and significantly associated with alcohol use. Further, depressive symptomology was a moderator of intervention effects as the effects of kiR on resistance strategies increased as the level of depressive symptomology increased. Study 2: this study explored subgroups (classes) of Mexican adolescents (N = 5,520, 11-14 years old) based on their experiences with violence (witnessing, victimization, and perpetration), depressive symptomology, and substance use (alcohol, tobacco, and marijuana). Using Latent Class Analysis (LCA) four empirically, well-differentiated classes emerged representing adolescents various risk typologies (Moderate Risk-Violence at 55% of the sample, Low Risk at 35%, High Risk at ~8%; and Moderate Risk-Substance Use at ~2%) Implications for research and practice are discussed across both studies.
ContributorsArévalo Avalos, Marvyn R (Author) / Spanierman, Lisa (Thesis advisor) / Dillon, Frank (Committee member) / Marsiglia, Flavio (Committee member) / Arizona State University (Publisher)
Created2021
Description
Background: The cost of substance use (SU) in the United States (U.S.) is estimated at $1.25 trillion annually. SU is a worldwide health concern, impacting physical and psychological health of those who use substances, their friends, family members, communities and nations. Screening, Brief Intervention (BI) and Referral to Treatment (SBIRT) provides an evidence-based (EB) framework to detect and treat SU. Evidence shows that mental health (MH) providers are not providing EB SU management. Federally grant-funded SBIRT demonstrated evidence of decreased SU and prevention of full disorders. Implementation outcomes in smaller-scale projects have included increased clinician knowledge, documentation and interdisciplinary teamwork.
Objective: To improve quality of care (QOC) for adolescents who use substances in the inpatient psychiatric setting by implementing EB SBIRT practices.
Methods: Research questions focused on whether the number of SBIRT notes documented (N=170 charts) increased and whether training of the interdisciplinary team (N=26 clinicians) increased SBIRT knowledge. Individualized interventions used existing processes, training and a new SBIRT Note template. An SBIRT knowledge survey was adapted from a similar study. A pre-and post-chart audit was conducted to show increase in SBIRT documentation. The rationale for the latter was not only for compliance, but also so that all team members can know the status of SBIRT services. Thus, increased interdisciplinary teamwork was an intentional, though indirect, outcome.
Results: A paired-samples t-test indicated clinician SBIRT knowledge significantly increased, with a large effect size. The results suggest that a short, 45-60-minute tailored education module can significantly increase clinician SBIRT knowledge. Auditing screening & BI notes both before and after the study period yielded important patient SU information and which types of SBIRT documentation increased post-implementation. The CRAFFT scores of the patients were quite high from a SU perspective, averaging over 3/6 both pre- and post-implementation, revealing over an 80% chance that the adolescent patient had a SU disorder. Most patients were positive for at least one substance (pre- = 47.1%; post- = 65.2%), with cannabis and alcohol being the most commonly used substances. Completed CRAFFT screenings increased from 62.5% to 72.7% of audited patients. Post-implementation, there were two types of BI notes: the preexisting Progress Note BI (PN BI) and the new Auto-Text BI (AT BI), part of the new SBIRT Note template introduced during implementation. The PN BIs not completed despite a positive screen increased from 79.6% to 83.7%. PN BIs increased 1%. The option for AT BI notes ameliorated this effect. Total BI notes completed for a patient positive for a substance increased from 20.4% to 32.6%, with 67.4% not receiving a documented BI. Total BIs completed for all patients was 21.2% post-implementation.
Conclusion: This project is scalable throughout the U.S. in MH settings and will provide crucial knowledge about positive and negative drivers in small-scale SBIRT implementations. The role of registered nurses (RNs), social workers and psychiatrists in providing SBIRT services as an interdisciplinary team will be enhanced. Likely conclusions are that short trainings can significantly increase clinician knowledge about SBIRT and compliance with standards. Consistent with prior evidence, significant management involvement, SBIRT champions, thought leaders and other consistent emphasis is necessary to continue improving SBIRT practice in the target setting.
Keywords: adolescents, teenagers, youth, alcohol, behavioral health, cannabis, crisis, documentation, drug use, epidemic, high-risk use, illicit drugs, implementation, mental health, opiates, opioid, pilot study, psychiatric inpatient hospital, quality improvement, SBIRT, Screening, Brief Intervention and Referral to Treatment, substance use, unhealthy alcohol use, use disorders
ContributorsMaixner, Roberta (Author) / Guthery, Ann (Thesis advisor) / Mensik, Jennifer (Thesis advisor) / Uriri-Glover, Johannah (Thesis advisor)
Created2019-05-02