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loss of temporary shelter, possessions or street partners). During extrication, youth attempt to leave street life. We hypothesized that youth in disequilibrium would engage in the highest rates of risk. Methods: We recruited a venue-based sample of 15-24 year old of street youth. Eligibility criteria included having been homeless the prior 2 nights or in the 6 months prior to recruitment. To supplement our sample of youth in extrication, we recruited some youth from transitional housing programs. Data were collected by audio computer assisted self-interview. Life cycle stage was measured with 5 items, then dichotomized into disequilibrium vs. other stages. History of survival sex and IDU were each measured by a single item. Recent history of sharing of needles and of works were elicited from youth with a history of IDU. Results: 215 youth were sampled (174 street-recruited and 41 program-recruited youth). The sample included 12 youth in initiation, 21 youth in stasis, 67 in disequilibrium, 74 street-recruited youth in extrication and 41 program-based youth in extrication. Gender distribution was 63% male and did not differ by stage. Mean age was 20.6 years and did not differ by stage. Youth in disequilibrium were more likely than other youth to have a history of survival sex (OR ϭ 1.99; 95% CI, 0.989-4.009) and to have a history of injection drug use (OR ϭ 2.32; 95% CI, 1.27-4.23). Of youth with a history of IDU (n ϭ 92), youth in disequilibrium were more likely to have injected in the last 3 months (OR ϭ 2.79; 95% CI, .934-8.338), and more likely to have shared needles (OR ϭ 3.70; 95% CI, 1.24-11.04)) or works (OR ϭ 3.09; 95% CI, 1.14-8.36). Youth in stasis had the lowest rates of survival sex of all stages, but this difference was not significant (OR ϭ 0.19, 95% CI 0.03-1.50). Conclusions: Youth in disequilibrium, whose ability to survive is disrupted, may engage in the highest rates of exchange sex, injection drug use and risky injection behaviors. Screening youth for disequilibrium may assist outreach and health care providers to identify the highest risk homeless youth for intensive intervention. Homeless youth in stasis, whose livelihood is not disrupted, may engage in lower rates of exchange sex than youth in other stages.

PURPOSE-Intervention studies that address the goals of the Healthy People initiative are increasing, and many focus on health concerns of children and adolescents. The purpose of this paper is to present strategies and discuss the rationale for including intervention fidelity in study design. CONCLUSION-Researchers need to verify that their interventions were delivered as designed (intervention fidelity), and that variations from the design can be assessed. Infidelity can result in non-significant findings that are not due to the study design but rather to elements that affected the intervention delivery. IMPLICATIONS-Addressing intervention fidelity in study design supports the researcher's conclusion about associations between intervention and outcomes and helps reduce premature abandonment of potentially useful interventions. Search terms-Experimental studies, fidelity, interventions, research Healthy People is a major public health initiative that was launched in the late 1970s to guide activities for promoting health and preventing disease (Ory, Jordan, & Bazzarre, 2002). In 1998, the National Institutes of Health implemented a policy to increase the inclusion of children in research studies of health concerns that affect them. As a result of these initiatives, intervention studies have been designed to address the different focal areas in the Healthy People reports, and many include children and adolescents in their samples. Integral to these interventions is the need to enhance intervention fidelity to ensure that internal validity of the study is maintained and external validity is enhanced. Two such health promotion intervention studies with school-age children and adolescents are being conducted by the first two authors who incorporated intervention fidelity strategies in their studies' designs. Stated simply, intervention fidelity means that the intervention was conducted as planned. Adherence to the intervention design advances the study aims (Nigg, Allegrante, & Ory, 2002), supports the researcher's conclusions about the association between the intervention and the study outcomes (Calsyn, 2000), and helps reduce premature abandonment of potentially useful interventions (Nigg et al.). Bellg et al. (2004) acknowledged that "methodologic procedures for preserving internal validity and enhancing external validity in studies…are not emphasized in research-training curricula, and their relative lack of perceived importance is also evidenced by the scant reporting of treatment fidelity practices in journal articles" (p. 443). While treatment fidelity was identified as early as the 1970s, it was during the 1990s that concern about the internal validity of intervention studies gained recognition (Bellg et al., 2004).

Question How do older adolescents perceive communication with their partners about sexual risk behaviour (multiple partners; sexual intercourse without condoms; or sexual intercourse with partners who have HIV infection, have a sexually transmitted disease [STD], or who use or have used intravenous drugs)? Design Grounded theory. Setting A public university in south east US. Participants 32 single adolescents (mean age 19 y, 56% women, 72% white, and mean age at first intercourse 17 y) who had never been pregnant or fathered a child and had had sexual intercourse. Methods A semistructured interview by a researcher of the same sex dealt with perceptions of decisions to have sexual intercourse and discussions with partners about birth control, previous sexual partners, STDs, and intravenous drug use. Interviews were analysed separately for men and women using constant comparative analysis.

Sexual health promotion is essential to the health and well-being of adolescents, including those with chronic health conditions. The purposes of this article are to define sexual health and to describe the physical, cognitive, psychosocial, and spiritual domains of adolescent development, with special focus on the sexual health needs of adolescents with various chronic health conditions. The article concludes with several suggestions for healthcare professionals, parents, and teachers in addressing sexual health promotion in this vulnerable population.

There is accumulating evidence that religiosity/spirituality (R/S) are important correlates of mental health in adult populations. However, the associations between R/S and mental heath in adolescent populations have not been systematically studied. The purpose of this article is to report on a systematic review of recent research on the relationships between adolescent R/S and mental health. Twenty articles between 1998 and 2004 were reviewed. Most studies (90%) showed that higher levels of R/S were associated with better mental health in adolescents. Institutional and existential dimensions of R/S had the most robust relationships with mental health. The relationships between R/S and mental health were generally stronger or more unique for males and older adolescents than for females and younger adolescents. Recommendations for future research and implications for mental health nursing are discussed. Mental health is one of the ten leading indicators of health identified in the national objectives published in Healthy People 2010 (U.S. Department of Health and Human Services, 2000). According to the National Institute of Mental Health (2004), 10% of children and adolescents

Mapping of the human genome raises interest in and concern about the genetic testing of adolescents. Our purpose was to determine the attitudes and knowledge adolescents and their parents have about genetic testing. DESIGN AND METHOD. This paper is a report of a systematic review of the research literature (n = 56) about the attitudes and knowledge adolescents and their parents have about genetic testing. RESULTS. The majority of studies, which were descriptive in design, focused on a specific heritable disorder, were conducted in the United States, and over sampled well-educated White females. PRACTICE IMPLICATIONS. Results suggest that adolescents and their families have relatively positive attitudes about genetic testing and may experience both harms and benefits from testing. Nurses may be in positions to assist adolescents and their families in making decisions about genetic testing, remaining sensitive to family dynamics and issues of privacy and autonomy.

To systematically review and synthesize literature concerning the relationships among religiosity, spirituality, health attitudes, and health behaviors in adolescents. Methods: Forty-three studies between 1998 and 2003 were systematically reviewed to (a) determine if the studies were based on conceptual or theoretical frameworks, (b) identify the types of religiosity and spirituality measures used as well as their effects on health attitudes and behaviors, (c) evaluate the quality of these measures, (d) determine categories and frequency of measures of health attitudes and behaviors, (e) evaluate the quality of the research designs, and (f) determine the effects of religiosity or spirituality on adolescent health attitudes and behaviors. Results: Over half (n ϭ 26) the studies were atheoretical or had an unclear framework and the other half were based on a wide variety of conceptual and theoretical models. A total of 37 distinct religiosity/spirituality variables were identified and varied in specificity. Less than half (n ϭ 21) reported reliability of the measures and only seven contained information about validity of the measures. All 43 studies included measures of health-risk behaviors and/or attitudes but only seven addressed health-promoting behaviors. Most studies (84%) showed that measures of religiosity/ spirituality had positive effects on health attitudes and behaviors. Conclusions: The variety of studies and measures indicate that religiosity and spirituality may be important correlates of adolescent health attitudes and behaviors. Although the majority of the studies reviewed were well designed, there was no consistency in the theoretical bases and operational definitions of religiosity/spirituality phenomena.

The United States remains an age-segregated society, resulting in both young and old missing out on potential health benefits of interacting with one another. Physical activity (PA) has the potential to promote intergenerational relationships and positive physical and psychological health outcomes for both generations. Yet, adolescents and older adults have low levels of PA. Social media provides unprecedented opportunities to promote PA and intergenerational interactions. Alternative high school (AHS) students have especially low levels of PA as compared to peers in traditional high schools and could benefit from feeling connected to a non-family adult, but little is known about social media use or intergenerational interactions among AHS students. The purpose of this descriptive study was to assess intergenerational interactions, social media use, and PA among AHS students and older adults (>/=60 years). Methods: We used data from two pilot surveys conducted in Central Texas in spring/summer of 2013. We administered one survey to students in one AHS (n=25; mean age 17.7 years; 92% youth of color; 67% low socioeconomic status) and a separate survey to older adults participating in a community program (n=35; mean age 72.97 years; 85.7% people of color; 68% with yearly income <$20,000). We used descriptive statistics to calculate proportions for a variety of questions related to intergenerational interactions, social media use, and PA.

Problem-Urban children who become competent adults despite circumstances that place their development and mental health at risk are considered to be resilient. Less is known about the risk and protective factors that characterize resilience among Hispanic/Latinos living in rural areas. Methods-Data for regression analyses were collected when children (N = 603; 54% Hispanic/ Latino) enrolled in the study in fifth grade, (M=10.4 years of age) and again five years later when they were in high school (M=15 years of age). Findings-Statistically significant predictors of competence and self-worth in high schoolers included gender, ethnicity, and mother's education, as well as stress, temperament (task persistence), and competences measured in grade school. Conclusions-Parents' perceptions of child's temperament is a significant predictor of future competence and self-worth among rural adolescents.

Aims and objectives. To synthesise the body of literature on workplace violence in the emergency department and to identify characteristics of intervention studies that are the basis for guiding best practice modelling in the clinical setting. The research question addressed was what are the characteristics and findings of studies since 2004 on workplace violence in the emergency department? Background. Emergency departments are prone to increased incidents of workplace violence. Workplace violence in the health care setting has become a hot topic of policy, political debate and research in recent years. Despite the research that has been carried out in this area, little consensus exists as to what are the best practices for mitigating violence in this setting. Design. Systematic literature review. Methods. Search using four online databases, including MEDLINE, CINAHL, PsycINFO and the Dissertations and Theses Full Text Database. Results. Most research focused on the incidence rates of workplace violence in the emergency department and effects on staff. There was a significant lack of intervention studies to provide a framework for guiding evidence-based practice. Themes of under-reporting violence, barriers and attitudes towards reporting, description and characterisation of incidents of violence, predisposing factors and the concept of safety or lack of fear were all major content areas addressed in the literature. Conclusions. Incidence of workplace violence in the emergency department has been well documented in numerous published studies. Emergency department workers are exposed to significant rates of physical and verbal abuse. Under-reporting of workplace violence in the emergency department is common and contributes to the difficulty in accurately tracking violence. Relevance to clinical practice. Future research must move beyond descriptive studies to include more advanced research methods. Few practice-guiding implications can be gained from this body of research because of the lack of intervention studies.

Substance use is highly prevalent among homeless, street-involved young people. Societal estrangement is often associated with substance use, particularly among this population. The current study utilized a descriptive correlational design to identify four domains of social estrangement: disaffiliation, human capital, identification with homeless culture, and psychological dysfunction. These domains were tested to determine their association with alcohol or drug dependence. Interviews utilizing self-report instruments were conducted with 185 young adults aged 18–23 years of age who were receiving homeless services from a community drop-in center. In this sample, the vast majority reported high levels of alcohol and drug use with more than half being identified as dependent on alcohol and/or drugs. Polysubstance use was highly prevalent and most reported marijuana as their drug of choice. Findings indicate that identification with homeless culture was the most highly predictive domai...

Holistic nurses and other holistic health care professionals are often characterized by their "capacity to accept the potential validity of medical therapies that may not have undergone the rigorous testing necessary to be considered standard of care" (Benda, 2004, p. 26). This claim begs at least two questions: Are other nursing specialties more successful at incorporating evidence into daily practice? and Where should holistic nurses go to find evidence for their practice? Nursing care that is based on the synthesis of clinical expertise, judgment, research findings of effective outcomes, and costeffectiveness is known as evidence-based practice. It has become the standard of care for professional nursing (Guzzetta, 2005; Stone, Curran, & Bakken, 2002). Evidence-based practice has long been the standard for care in some nursing specialties such as perinatal nursing. However, even in these settings nurses often encounter barriers to incorporating research findings into their daily practice. Barriers that nurses have identified include the fact that reading and understanding research is time-consuming. Many nurses lack knowledge about research methods and statistical analyses. Moreover, nurses frequently assert that there is minimal administrative support to implement research findings in practice (Carr & Schott, 2002). Just as perinatal nurses face barriers to providing evidence-based practice, so do holistic nurses. According to leaders in nursing who met at the Gillette Nursing Summit on Integrated Health and Healing to discuss the role of nursing in the emerging field of integrative health care, the incorporation of disparate, and sometimes unusual, interventions in health care practices should be based on supportive 295

It is well known among professionals who work in academic settings that one must "publish or perish." That is, an academician, particularly one who is in a tenure-track position at a major college or university, must have a minimal number of manuscripts published from year to year or risk the possibility of losing the job. This expectation has not been extended to other professional arenas, but perhaps it should be. After all, the written word still communicates information that is essential to the survival of a professional discipline. Within nursing, who should publish? What should they publish? And why is publishing so vital? Every professional nurse who wants to contribute fully to the health and welfare of nursing clients should publish! Realistically, if that expectation were met, we would need many more professional journals than we currently have. But just think about what this means. Every time a nurse creates an intervention that is effective in reducing suffering or promoting health, that information needs to be shared with other nurses. If the nurse keeps this information to himself or herself, fewer clients are able to benefit from the intervention than would be possible if the intervention were to be described clearly in a professional journal. A nurse does not need a particular set of academic credentials to be a credible author. Some journals focus primarily on practical applications of nursing knowledge, whereas others focus more on systematic reports of research. There is a place for everyone, believe it or not! 317

Adolescence is a time of promise, when the major physical, cognitive, and relational transitions to adulthood begin to achieve the potential that is inherent in every growing child. It is also a time of risk, when the challenges of a child's environment, family, relationships, and resources can derail that promising trajectory and create patterns of diminished health and lost opportunity in the years to come. Many of the risky behaviors linked to poor health in adulthood-smoking, substance use, poor diet, unsafe sexual practices-begin in adolescence. Although the majority of young people have a wealth of guidance and loving support to help them navigate the teen years, such resources are not universal. Far too many youth throughout the world negotiate their transitions amid poverty and violence, trying to survive and thrive in what Barker and Musick call "developmentally toxic environments" (1994, p. 159). Some adolescents do survive in the face of overwhelming risk factors; some even thrive. In the midst of toxic environments, these adolescents draw on individual, interpersonal, or environmental factors that allow them to weather the risks inherent in their lives. In the past two decades, we have begun to identify these protective factors, which are also called assets and strengths. At the same time, we have recognized that a focus solely on the risks and problems facing adolescents has brought too little effective change. It is easy to feel overwhelmed by the complex problems that adolescents face and discouraged by lack of progress in removing the risks.

A common assumption about school-aged children is that they are basically healthy. However, recent evidence suggests that children under the age of 5 years are healthier than those between 5-17 years (Federal Interagency Forum on Child and Family Statistics, 2003). Health behaviors (i.e., health-promoting and health-risk behaviors) of school-age children and early adolescents originate at the intersection of genetic, environmental, and social variables. Some behaviors can protect and promote healthy bodies, quality social relationships, mastery of life's tasks, meaning and purpose in life, and resilience to stress and change (Institute of Medicine, 2001). However, not all children engage in healthpromoting behaviors and, by the time they reach adolescence, their health behaviors are often better described as health-risk behaviors including poor nutrition, lack of physical activity, smoking, drinking alcohol and using non-prescribed drugs, having unprotected sex, and carrying weapons or fighting (Brindis, Park, Ozer, & Irwin, 2002). In their review of national data sets, researchers at the National Adolescent Health Information Center (Ozer, Park, Paul, Brindis, & Irwin, 2003) provided ample evidence that health-risk behaviors increase from grades 8-12 and in the lower grades, such behaviors are highest among Hispanics. Researchers have shown that health-risk behaviors tend to increase with age (Cartland & Ruch-Ross, 2006) and are related to male gender (Wu, Rose, & Bancroft, 2006), ethnicity (Ozer et al., 2003), and family structure (Brener & Collins, 1998; Rouse, Ingersoll, & Orr, 1998). Several health-risk behaviors that vary by ethnicity and gender have been identified in school-age children and early adolescents, including disordered eating and aggression in young Hispanic females (McLaughlin, Hilt, & Nolen-Hoeksema, 2007). At present, very little is known about the development of health behaviors in children and early adolescents, particularly among the growing population of Hispanics. Therefore, the purpose of this study was to describe the health behaviors, both health-promoting and health-risking, of school-age children and how they differ by grade level, gender and ethnicity. A second purpose was to determine how health behaviors are related to factors that may either promote or impede health.

Recognizing the need for a valid and reliable way to measure outcomes of a program to promote multicultural awareness among nursing faculty and students, the authors developed a cultural awareness scale. In the first phase of the study, a scale consisting of 37 items was generated from a literature review on cultural awareness, sensitivity, and competence in nursing. A Cronbach's alpha reliability coefficient of .91 was obtained from a sample of 72 student nurses. In the second phase, the items were presented to a panel of experts in nursing and culture to determine content validity. A content validity index of .88 was calculated, and the total number of items on the scale was reduced to 36. The scale then was administered to 118 nursing students. Data from the two samples then were combined, and factor analysis was conducted to support construct validity. Cronbach's alpha for the combined samples was .82.

Background: Men between the ages of 20 and 34 years are at highest risk for testicular cancer yet many lack knowledge and confidence in performing self-examination. The Self-Efficacy to Perform Testicular Self-Examination Scale (SEPTSES) is a 7-item questionnaire to be completed by men, which is designed to measure their confidence in self-examining their testicles. The purpose of this methodological study was to determine the validity and reliability of this selfreport measure. Methods: Content validity of the scale and clarity of items were established with a panel of experts. The SEPTSES and three valid scales of related constructs were completed by two samples of men (homeless [n = 150] and non-homeless [n = 156]) aged 18-34 years. Results: A single factor explained 51.5% of the variance of the scale and Cronbach's alpha was satisfactory (a = 0.84). Construct validity was further supported by significant correlations with the other three scales; further support was established by a significant difference in mean scores between the two samples [t (303) = −5.44, p < 0.001]. Conclusion: The SEPTSES is a valid, unidimensional scale and it can be used in further research and in clinical practice as an assessment of this aspect of men's health.

Advances in genomic science create both opportunities and challenges for future generations. Both adolescents and adults may benefit or be harmed by decisions they make in response to this new science. Using a qualitative descriptive design, the authors interviewed 22 adolescents (11 who were aged 14-17 years and 11 who were 18-21 years) and 11 parents to determine levels of knowledge and approaches to decision making. It was found that younger adolescents and their parents have very limited knowledge about genetics and genetic testing. Older adolescents have more complete information and consider a broader range of points in making decisions about hypothetical situations involving genetic testing. Adolescents and parents need much more information to enhance their ability to make decisions about using genetic services. These findings have implications for developing interventions and public health policy highlighted by the need for improved education about the benefits and harms of...