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As nursing continues to advance health care in the 21st century, the current shift in demographics, coupled with the ongoing disparities in health care and health outcomes, will warrant our ongoing attention and action. As within all health professions, concerted efforts are needed to diversify the nation's health-care workforce. The nursing profession in particular will be challenged to recruit and retain a culturally diverse workforce that mirrors the nation's change in demographics. This increased need to enhance diversity in nursing is not new to the profession; however, the need to successfully address this issue has never been greater. This article discusses increasing the diversity in nursing and its importance in reducing health disparities. We highlight characteristics of successful recruitment and retention efforts targeting racial/ethnic minority nurses and conclude with recommendations to strengthen the development and evaluation of their contributions to eliminating health disparities.

Half of all new human papillomavirus (HPV) infections occur in adolescents and young adults, and this population has poor HPV vaccination rates. Rural areas of the U.S. have high rates of HPV-related diseases and low vaccination rates as well. The purpose of this study was to determine the perceived barriers and facilitators to HPV vaccination among adolescents and their caregivers in rural south Alabama. Vaccinated and non-vaccinated adolescents ages 11–18 years old and primary caregivers were recruited from three rural counties in south Alabama. Participants completed individual interviews to discuss perceived barriers to vaccination and factors influencing their decision to vaccinate. Discussion groups were held to determine potential solutions to barriers elucidated from the interviews. Interview and discussion group transcripts were analyzed, and themes were identified. Approximately 62.5% of adolescents had not initiated the HPV vaccine series. Of those adolescents who started the vaccine series (n = 9, 37.5%), about half completed it (n = 5). Few participants in this study reported speaking with their health care provider (HCP) about the vaccine in the past year. Lack of information about the vaccine, its side effects, and no HCP recommendation were common barriers cited by non-vaccinators. Facilitators to vaccination included cancer prevention, discussion with HCP, and peer testimonials. Potential solutions to barriers were also discussed. Proposed strategies to increase HPV vaccination were similar between vaccinated and non-vaccinated groups. Education about HPV and the HPV vaccine is needed throughout these rural south Alabama communities to ensure informed decisions are made about vaccination and to increase vaccination rates.

Policy advocacy and committed resources are essential to address social factors that shape population health. In this article, we discuss nurse advocacy to advance public health and health equity through targeted social determinants, particularly on behalf of poor and disadvantaged persons. We discuss components of the right social policies and consider evidence-based policies that have linked improvements in social and economic conditions with increased physical, emotional, and mental health outcomes among poor and disadvantaged social groups. With a partnership perspective, select social determinants of health (SDOH) and mitigating policies focus nurses' social policy advocacy to improve the health of disadvantaged populations and reduce health inequities. We suggest nurses engage in multisectoral partnerships and adopt a Health in All Policies (HiAP) approach to address social and health needs of concern. The conclusion offers resources and strategies to promote nurse engagement in health policy.

Objective: In the search of solutions to the rising rates of obesity, community perspec­tives are important because they highlight areas of need and help determine the level of community support for potential interventions. This study aimed to identify community perceptions of factors associated with obesity in two urban municipalities – one racially mixed and one predomi­nantly African American – and to explore community-driven solutions to the problem of obesity. Methods: The study used Photovoice meth­odology to understand what community members perceived as obesity-promoting factors in their residential environments. Results: A total of 96 photographs of factors relevant to obesity were discussed. Most commonly depicted were restaurants, gro­cery stores, fast food, and fitness centers. In 10 race-stratified focus groups, participants made 592 comments on 12 themes, the most common being restaurants, physical activity, food stores, and proposed solutions. The top three themes – restaurants, physical activity, and food stores – accounted for 58% of all barriers to healthy weight. Pro­posed solutions ranged from personal efforts and peer support, to educating adults and children, to community action. Conclusion: Interventions addressing the immediate food and physical activity environment – restaurants, grocery stores, and resources for physical activity – may have high likelihood of success as they align with community needs and understanding of priorities. Health education and promo­tion programs that increase food-related knowledge and skills are also needed and likely to receive strong community support. Ethn Dis. 2018;28(1):33-42; doi:10.18865/ ed.28.1.33.

Communication technologies can play a significant role in decreasing communication inequalities and cancer disparities by promoting cancer control and enhancing population and individual health. Studies have shown that technology, such as the mobile phone short message service (SMS) or text messaging, can be an effective health communication strategy that influences individuals' health-related decisions, behaviors, and outcomes. The purpose of this study was to explore usage of communication technologies, assess the acceptability of mobile technology for delivery and access of health information, and identify cancer and health information needs among Deep South Network for Cancer Control trained Community Health Advisors as Research Partners (CHARPs). A mixed-method design was used, and a triangulation protocol was followed to combine quantitative and qualitative data. Focus groups (4 focus groups; n=37) and self-administered surveys (n=77) were conducted to determine CHARPs mobile phone and text message usage. The objective was to include identification of barriers and facilitators to a mobile phone intervention. All participants were African American (37/37, 100%), 11/37 (89%) were women, and the mean age was 53.4 (SD 13.9; focus groups) and 59.9 (SD 8.7; survey). Nearly all (33/37, 89%) of focus group participants reported owning a mobile phone. Of those, 8/33 (24%) owned a smartphone, 22/33 (67%) had a text messaging plan, and 18/33 (55%) and 11/33 (33%) received and sent text messages several times a week or day, respectively. Similar responses were seen among the survey participants, with 75/77 (97%) reporting owning a mobile phone, and of those, 22/75 (30%) owned a smartphone, 39/75 (53%) had a text messaging plan, and 37/75 (50%) received and 27/75 (37%) sent text messages several times a week or day. The benefits of a text messaging system mentioned by focus group participants included alternative form of communication, quick method for disseminating information, and privacy of communication. The main barriers reported by both groups to using mobile technology to receive health information were cost and not knowing how to text message. Ways to overcome barriers were explored with focus group participants, and education was the most proposed solution. Majority of CHARPs were in favor of receiving a weekly text message that would provide cancer/health information. The findings from this study indicate that CHARPs are receptive to receiving text messages focusing on cancer/health information and would be likely to engage in mobile health research. These findings represent the first step in the development of an interactive mobile health program designed to provide cancer/health information and a support network for the Deep South Network Community Health Advisors as Research Partners (DSN CHARPs).

Background Executive function (EF) is associated with obesity development and self‐management. Individuals who demonstrate or self‐report poorer EF performance tend to have poorer short‐term outcomes in obesity treatment. There may be distinct behavioral self‐management strategies and EF domains related to initial weight loss as compared to weight loss maintenance. Objective To characterize EF in individuals who achieved clinically significant weight loss via behavioral intervention and examine potential differences in EF between those who maintained versus regained lost weight. Methods Participants who previously achieved ≥5% weight loss via lifestyle intervention were included (N = 44). “Maintainers” (n = 16) maintained this minimum level of weight loss for ≥1 year. “Regainers” (n = 28) regained some or all initially lost weight. Performance‐based EF, intelligence quotient, health literacy, depression, anxiety, binge eating, demographics, and medical/weight history were assessed using a cross‐sectional design. Descriptive statistics and age‐, gender‐, education‐adjusted reference ranges were used to characterize EF. Analyses of covariance were conducted to examine EF differences between maintainers and regainers. Results The sample consisted primarily of females with obesity over age 50. Approximately half self‐identified as African–American. Decision‐making performance was better in maintainers than regainers (p = 0.003, partη2 = 0.19). There were no differences between maintainers and regainers in inhibitory control, verbal fluency, planning/organization, cognitive flexibility, or working memory (ps > 0.05, partη2s = 0.003–0.07). At least 75% of the sample demonstrated average‐above average EF test performance, indicated by scaled scores ≥13 or t‐scores > 60. Conclusions Most individuals with obesity who achieved clinically significant weight loss via behavioral intervention had average to above average EF. Individuals who maintained (vs. regained) their lost weight performed better on tests of decision‐making.

Mobile phone-based interventions can play a significant role in decreasing health disparities by enhancing population and individual health. The purpose of this study was to explore health ministry leaders (HMLs) and congregation members’ communication technology usage and to assess the acceptability of mobile technology for delivery of cancer information. Six focus groups were conducted in two urban African-American churches with trained HMLs ( n  = 7) and congregation members ( n  = 37) to determine mobile phone technology usage and identify barriers and facilitators to a mobile phone intervention. All participants were African-American, majority were female (80 % of HMLs; 73 % of congregation members), and the mean age was 54 (HMLs) and 41 (congregation members). All of the HMLs and 95 % of congregation members indicated owning a mobile phone. All HMLs reported sending/receiving text messages, whereas of the congregation members, 85 % sent and 91 % received text messages. The facilitators of a text messaging system mentioned by participants included alternative form of communication, quick method for disseminating information, and accessibility. The overall main barriers reported by both groups to using mobile technology include receiving multiple messages, difficulty texting, and cost. Ways to overcome barriers were explored with participants, and education was the most proposed solution. The findings from this study indicate that HMLs and congregation members are interested in receiving text messages to promote healthy lifestyles and cancer awareness. These findings represent the first step in the development of a mobile phone-based program designed to enhance the work of health ministry leaders.

Purpose The purpose of this study was to assess nurses’ knowledge, perceived self‐efficacy, and intended behaviors relative to integrating the social determinants of health (SDoH) into clinical practice. Design and Methods A cross‐sectional study was completed with 768 nurses working in three hospitals within a large regional healthcare system located in the Midwest. Data were collected using an adapted 71‐item SDoH Survey, which measured nurses’ confidence in and frequency of discussing the SDoH with patients, general knowledge of the SDoH, familiarity with patients’ social and economic conditions, and awareness of their institution’s health equity strategic plan to achieve health equity. The institution’s health equity strategic plan reflects the organization’s commitment to improving the health of individuals and neighborhoods by addressing the SDoH known to influence health status and life expectancy. Finally, participants were asked to describe barriers to incorporating the SDoH into practice along with completing five demographic items. Descriptive statistics were used to describe the findings. Findings Of the 768 respondents, 63% had a baccalaureate degree in nursing and 33.1% reported more than 20 years in nursing. Fifty percent of respondents reported feeling more knowledgeable or confident in their ability to discuss access to care issues with patients compared to the other SDoH. Identified barriers to discussing the SDoH included insufficient time to address identified needs and unfamiliarity with internal and external resources. Respondents stressed the need for interdisciplinary education and collaboration along with more information on the role of social workers. Conclusions Nurses are more confident in discussing certain determinants of health and could benefit from more skill development in discussing SDoH issues and stronger collaborative partnerships to address identified needs. Clinical Relevance Findings from the study have implications for supporting the educational and resource needs of front‐line nurses employed in hospitals and health systems seeking to address broader societal issues influencing the health status and outcomes of patients and communities.

Technology integration within health care allows clinicians faster access to patient information. Without timely documentation, however, providers' clinical decisions are not supported by up-to-date patient information. Determine the relationship of a documentation device's location to the timeliness of adult assessment data entry. Identify nurses' perceptions of use efficiency, facilitators, and barriers to documentation in the electronic health record at various computer locations. A descriptive study was completed using 318 chart reviews and survey responses from 25 nurses employed in a community-based hospital. Data were collected using an investigator-developed chart review and survey tool. Bedside documentation entries produced a more significant proportion of timely adult assessment entries than entries performed at the nurses' station (p<0.01).

Both monkey and human studies have suggested that attentional orienting may be mediated by the cholinergic neurotransmitter system. The purpose of the present study was to examine whether the cholinergic agonist (nicotine) and/or antagonist (scopolamine) influence covert orientation in the rat. Rats carried out a visual reaction time task to measure covert orienting of attention following systemic administration of nicotine or scopolamine. Nicotine reduced reaction times, abolishing the validity effect by differentially speeding the reaction times for invalidly cued targets. Conversely, scopolamine increased the validity effect by disproportionately lengthening reaction times to invalidly cued targets. Taken together, these data indicate that cholinergic transmission represents an important neurochemical substrate of visuospatial attention, specifically influencing disengagement or movement of attention.