Michelle A. Mathiason

About one in four U.S. high school students experience peer bullying victimization. Although discrimination based on socially stigmatized identities is increasing, there are few studies examining ethno-racial and religion-identity-based bullying (IBB), or whether school diversity or rural-urban settings modify such bullying experiences. We conducted a cross-sectional analysis of the 2016, 2019 and 2022 Minnesota Student Surveys of eighth and ninth graders. We assessed the associations of bullying victimization due to race/ethnicity/national origin and religion with school ethno-racial diversity, and geographical location by ethno-racial group using multilevel multivariate logistic regression models with random intercepts for schools. Overall, rates of ethno-racial and religious- based bullying were highest in rural (23.7%) and suburban (21.8%) schools. Ethno-racial-based bullying was higher among Black (44.2%), Black Latine (43.8%) and Hmong (40.4%) students in rural areas. Religion-based bullying was most prevalent in rural (10.1%) and urban schools (9.6%) and among Somali students across all locales (21.7% urban, 25.2% suburban and 28.4% town/rural). School ethno-racial diversity was protective against ethno-racial IBB only and for some groups (Black, Asian, multiracial) and not others (e.g., American Indian Alaskan Native, Somali, white). We found differences in the percentage of students reporting IBB by ethno-racial group, school diversity, and school geographic location. Generally, diverse school contexts were associated with a decrease in ethno-racial IBB for most students, especially in suburban schools. It is important to account for subgroup differences in addressing IBB to identify protective contexts. Our findings point to the need for systemic efforts to facilitate positive interpersonal relations in schools, such as policies and training that support teachers as role models and agents of socialization.

Electronic health records (EHR) provide high-volume data about postpartum breastfeeding care. Despite the importance of exclusive breastfeeding as a quality indicator, there is no standardized method for analyzing this data. Following a systematic approach, we applied an EHR preparation framework to flowsheet documentation to evaluate data quality and create indicators of breastfeeding support (number of documented support interactions/expected number of interactions = support ratio) and breastfeeding intensity (number of breastmilk feedings/total feedings). A stepwise framework of (1) data extraction, (2) cohort development, (3) variable compilation, and (4) analysis was applied to data from a single hospital system in Minnesota available through a clinical data repository. In all, 33,285 dyads were included in the analysis. The overall mean support ratio was 2.33; 1.0 indicates the minimum support goal was met. Mean breastfeeding intensity by hospital ranged from 0.62 to 0.90 (0.84 overall). Over 50% of dyads were missing documentation for lactation care indicators, and none had complete data for all indicators. The selected indicators may be used in future research as a standardized method of evaluating breastfeeding support and outcomes during the postpartum hospital stay, and may be adapted for other research where repeated flowsheet measures are used.

Supportive interactions that facilitate the labeling of emotions and problem-solving abilities are linked to family well-being and youth resilience. The purpose of this study was to explore youth perceptions of a narrative sharing intervention, and to identify differences in perceptions based on measures of youth resilience. We used an integrated mixed methods, action research approach with 294 youth. Participants completed a timelining activity, interview, and measures of peer and family relationships and well-being. We used latent class analysis and thematic analysis followed by integration of quantitative and qualitative data. Latent class analysis revealed subgroup patterns based on measures of resilience and family and peer relationships. Participants perceived the timelining activity as a tool to help others understand and appreciate the extent of their struggles and resilience. Timelining may be a useful activity to support parent-peer and peer-peer conversations about coping and resilience. These findings can inform family nursing intervention development.

Background: While COVID-19 has lessened in urgency for the general United States population’s day-to-day functioning, it continues to have significant impact for those who live with a wide range of ongoing sequelae. Wide variation of Long COVID symptoms must be considered as nurses facilitate holistic patient-centered care. Objectives: We aimed to describe patients’ symptom experiences from 3 to 12 months following COVID-19 hospitalization. Methods: A longitudinal descriptive design was used to explore adults’ symptom experiences of Long COVID at 4 time points up to 12 months following hospital admission for COVID-19 between October 2020 and May 2022. Results: Most of the 37 participants (87%) continued to experience at least 1 physical symptom at 12 months, which was not significantly different than at 3 months (90%). Fatigue was the most common symptom reported at all the time points. Group mean scores on all PROMIS measures and the Impact of Events Scale-Revised did not indicate dysfunction; however, 37% reported having somewhat or a lot of symptom impact on their normal routines. In addition, at least 50% reported currently experiencing quality of life worse than prior to COVID at each time point. Conclusions: Long COVID symptoms continue to affect significant numbers of people with ongoing impact to daily routines and quality of life. Nurses are in a unique position to generate new evidence on identifying the subset of patients recovering from COVID-19 who are at higher risk for developing Long COVID and provide holistic assessments, monitoring, and interventions to mitigate patients’ physical, emotional, and mental health symptoms.

Background: The complex work of public health nurses (PHNs) specifically related to mental health assessment, intervention, and outcomes makes it difficult to quantify and evaluate the improvement in client outcomes attributable to their interventions. Objectives: We examined heterogeneity across parents of infants served by PHNs receiving different interventions, compared the ability of traditional propensity scoring methods versus energy-balancing weight (EBW) techniques to adjust for the complex and stark differences in baseline characteristics among those receiving different interventions, and evaluated the causal effects of the quantity and variety of PHN interventions on client health and social outcomes. Methods: This retrospective study of 4,109 clients used existing Omaha System data generated during the routine documentation of PHN home visit data. We estimated the effects of intervention by computing and comparing weighted averages of the outcomes within the different treatment groups using two weighting methods: (a) inverse probability of treatment (propensity score) weighting and (b) EBWs. Results: Clients served by PHNs differed in baseline characteristics with clients with more signs/symptoms. Both weighting methods reduced heterogeneity in the sample. EBWs were more effective than inverse probability of treatment weighting in adjusting for multifaceted confounding and resulted in close balance of 105 baseline characteristics. Weighting the sample changed outcome patterns, especially when using EBWs. Clients who received more PHN interventions and a wider variety of them had improved knowledge, behavior, and status outcomes with no plateau over time, whereas the unweighted sample showed plateaus in outcomes over the course of home-visiting services. Discussion: Causal analysis of PHN-generated data demonstrated PHN intervention effectiveness for clients with mental health signs/symptoms. EBWs are a promising tool for evaluating the true causal effect of PHN home-visiting interventions.

Background: Symptoms in children with acute lymphocytic leukemia (ALL) change over the trajectory of treatment but little is known about their symptoms as treatment ends. Physical activity may help decrease symptom distress and is vital for ongoing development. The role of biomarkers in symptom science is emerging. The purpose of the study was to explore relationships between self-report of symptoms and physical activity, actigraphy measures, and cerebrospinal fluid (CSF) biomarkers. Methods: Participants were children who were ages 3 to 18 years at the time of ALL diagnosis and were now in the last 12-week cycle of ALL maintenance. Self-reports of fatigue, sleep disturbance, depressive symptoms, and physical activity were completed by participants and parents of younger children. Participants wore a wrist actigraph continuously for the 7 days before other measurements. F2-isoprostanes and interleukin-8 were evaluated in CSF samples. Results: Among the 15 participants, self-report of symptoms and physical activity indicated levels similar to healthy peers. F2-isoprostane had a strong positive correlation with fatigue levels and with depressive symptoms. Fatigue, sleep disturbance, and depressive symptoms positively correlated with each other. Actigraph measures showed children met the CDC guidelines for 60 min of daily moderate to vigorous activity; sleep time was slightly less than healthy norms. Discussion: During maintenance therapy, most children return to healthy norms in symptom burden and physical activity. F2-isoprostane in the CSF is a biomarker for fatigue and depressive symptoms. Children who had persistent symptoms experienced them as a cluster, which confirms previous symptom cluster research.

Purpose: Pediatric obesity disproportionately impacts Hispanic or Latino/a adolescents. Culturally appropriate family-based behavioral initiatives to improve weight status are warranted. The purpose of this research was to determine prevalence rates and identify protective factors associated with having overweight/obesity (body mass index ≥ 85 ^th percentile) to inform Hispanic or Latino/a-targeted behavioral intervention development. Design: Secondary data analyses of a population-based statewide survey. Setting: Minnesota public high schools. Participants: Male (n = 2,644) and female (n = 2,798) Hispanic or Latino/a 9 ^th and 11 ^th graders (N = 5,442). Measures: Obesity-related behaviors (meeting fruit and vegetable [F&V] and physical activity [PA] recommendations), family caring, family country/region of origin, and weight status. Analysis: Stepwise logistic regression models (F&V, PA), stratified by biological sex, were used to identify protective factors of overweight/obesity. Results: The overall prevalence of meeting F&V and PA recommendations was 11.0% and 11.8%, respectively. Meeting F&V recommendations was not protective against overweight/obesity in either sex. Yet, males and females who met PA recommendations had significantly lower odds of having overweight/obesity ( p < .05). In F&V and PA models, family caring was protective against overweight/obesity in females ( p < .05), and family country/region of origin was protective against overweight/obesity in both sexes ( p < .05). Conclusion: Findings illustrate a need for obesity prevention initiatives for Hispanic or Latino/a youth. More research is needed to understand the protective nature of family caring and country/region of origin.