Type 2 diabetes mellitus is the most common form that exists and has many variables that play into its development and diagnosis. This study looks at some of the factors that may have played an impact on people who are pre-diabetic or at risk of being pre-diabetic. Pre-diabetes can often serve as a warning sign for people and presents them with an opportunity for intervention before their condition worsens. However, it often goes unnoticed due to the lack of education regarding healthy living and making better quality-of-life decisions in Hispanic communities. The purpose of this study was to help identify patterns in how people from these communities manage their conditions and find techniques that can be replicated by others in order to improve health outcomes. This study followed a mixed methods approach in order to gain a full understanding of the quantitative (QUAN) and qualitative (QUAL) aspects that may have an impact on diabetes. Data was collected using a questionnaire to analyze different aspects and lifestyles of the participants and an interview with probing questions regarding life decisions, beliefs, and expectations. The overarching research question was “How did varying levels of health motivation and healthful eating habits affect glycosylated hemoglobin levels (HbA1c) in Hispanic/Latinx populations who are at risk of or are pre-diabetic?”. With this, we can obtain a better understanding of certain key aspects that play a role in the development of diabetes. A correlations matrix analysis was run to test how certain variables related and caused changes with one another. To analyze how these variables related specifically to HbA1c, our dependent variable, a multiple regression model analysis was used. It was found that the main contributors to elevated HbA1c levels were health motivation and age. A joint display analysis combined different levels of health motivation, QUAN data, and the responses to a focus question regarding efforts taken to improve one's condition, QUAL. This displayed a pattern of participants with higher health motivation showing efforts to reduce their diabetes risk and by contrast, low health motivation participants showing minimal to no efforts in changing behavior. This study found that elevated HbA1c levels also come with higher health motivation which normally wouldn’t make sense. However, the participants from this study knew about their HbA1c levels before this survey was conducted which means that these people already knew about the dangers of their condition and may have been taking steps to mitigate further risk. This demonstrates the importance of developing education systems to help inform people about risk factors and symptoms to alert them of their condition. It is common in Hispanic areas for people to cook high-fat foods, lard, or oil which often lead to an increased risk of diabetes. There is also a great difference in the amount of resources that Hispanic communities have for practicing healthy lifestyle habits and less effective self-monitoring that makes it difficult to recognize early signs of diabetes. Promoting interventions that help educate about the risks of diabetes could encourage great change in eating habits, activity levels, and overall health outcomes for people from Hispanic communities.

ABSTRACTThe purpose of this project was to discover how expert nurse faculty teach noticing and cue recognition skills to undergraduate nursing students. The current health care environment is complex, requiring new nurses to apply sound clinical judgment for safe patient care. New nurses often struggle with the first phase of clinical judgment, which includes noticing or cue recognition. Nurse educators often say that they teach clinical judgment skills, however specific guidelines to accomplish this task are limited. This study employed a qualitative exploratory descriptive design. Expert nursing faculty (N=18) from across the USA were nominated by peers and participated in semistructured interviews in person or via webinar. Interviews were recorded, transcribed, verified, and then coded using open and axial coding procedures in a grounded theory approach. Themes were confirmed by three educators with experience in teaching clinical judgment. Fifteen themes emerged. Faculty employed a variety of methods to teach cue recognition skills. In the clinical setting, faculty reported using orientation to the environment, Socratic questioning, role modeling, guidance in cue collection, and open discussion. Faculty teaching in simulation settings reported manipulating cues to reflect real time consequences of missing cues and manipulating cues based on best available evidence related to the scenarios. Authentic clinical environments and human patient simulation provide opportunities for undergraduate nursing students to learn cue recognition and noticing skills. However, students need the support of nurse educators to guide their learning and maintain overall safety. Expert nurse faculty possess a wealth of knowledge in how to teach clinical judgment. Nurse educators reported using methods suitable across settings and methods specific to clinical or simulation settings. The methods and strategies that expert nurse educators reported for supporting students in clinical judgment can be used to build and refine professional development programs for novice and continuing nurse educators.

In past decades, adverse childhood experiences (ACEs) rapidly gained attentionas a public health crisis due to dose-response relationships with a range of health and social problems, and early mortality. Converging studies show that ACEs are a pandemic in the general population of the United States—even in middle to upper-middle class families that are considered to be ‘better off’. There have been collaborative efforts in public health to target root-causes of childhood adversity and increase resilient adaptation in individuals and families at risk. Due to the importance of fostering positive adaptation in the midst of adversity, this dissertation sought to examine both vulnerability and protective factors in children’s proximal ecology—e.g., parents and caring adults at school. A population-based study in this dissertation revealed that parents’ emotional well-being, measured as negative feelings toward parenting, greatly influences developing children, so as support and resources for parenting. The presence of caring adults as a protective factor in teens with highly competitive settings—a newly identified at-risk group due to high pressure to achieve and internalizing/externalizing problems. Lastly, this dissertation discusses conceptual and methodological limitations in current ways of measuring ACEs and provide future directions for research, practice, and policy. Suggestions include frequent assessments on reaching consensus on how to define ACEs, expanding the concept of ACEs, considering the duration, timing, and severity of the event. Healthcare professionals have important roles in public health; they incorporate frequent assessments on parents’ emotional wellbeing and needs for parenting as a part of care. Ongoing support from multiple disciplines is necessary to reduce the impact of ACEs and strengthen resilience development of children and families.

Background
Obese Latino adolescents are disproportionately impacted by insulin resistance and type 2 diabetes. Prediabetes is an intermediate stage in the pathogenesis of type 2 diabetes and represents a critical opportunity for intervention. However, to date, no diabetes prevention studies have been conducted in obese Latino youth with prediabetes, a highly vulnerable and underserved group. Therefore, we propose a randomized-controlled trial to test the short-term (6-month) and long-term (12-month) efficacy of a culturally-grounded, lifestyle intervention, as compared to usual care, for improving glucose tolerance and reducing diabetes risk in 120 obese Latino adolescents with prediabetes.
Methods
Participants will be randomized to a lifestyle intervention or usual care group. Participants in the intervention group will attend weekly nutrition and wellness sessions and physical activity sessions twice a week for six months, followed by three months of booster sessions. The overall approach of the intervention is framed within a multilevel Ecodevelopmental model that leverages community, family, peer, and individual factors during the critical transition period of adolescence. The intervention is also guided by Social Cognitive Theory and employs key behavioral modification strategies to enhance self-efficacy and foster social support for making and sustaining healthy behavior changes. We will test intervention effects on quality of life, explore the potential mediating effects of changes in body composition, total, regional, and organ fat on improving glucose tolerance and increasing insulin sensitivity, and estimate the initial incremental cost effectiveness of the intervention as compared with usual care for improving glucose tolerance.
Discussion
The proposed trial builds upon extant collaborations of a transdisciplinary team of investigators working in concert with local community agencies to address critical gaps in how diabetes prevention interventions for obese Latino youth are developed, implemented and evaluated. This innovative approach is an essential step in the development of scalable, cost-effective, solution oriented programs to prevent type 2 diabetes in this and other populations of high-risk youth.

In the present research, two interventions were developed to increase sun protection in young women. The purpose of the study was to compare the effects of intervention content eliciting strong emotional responses to visual images depicting photoaging and skin cancer, specifically fear and disgust, coupled with a message of self-efficacy and benefits of sun protection (the F intervention) with an intervention that did not contain an emotional arousal component (the E intervention). Further, these two intervention conditions were compared to a control condition that contained an emotional arousal component that elicited emotion unrelated to the threat of skin cancer or photoaging (the C control condition). A longitudinal study design was employed, to examine the effects of condition immediately following the intervention, and to examine sun protection behavior 2 weeks after the intervention. A total of 352 undergraduate women at Arizona State University were randomly assigned to one of the three conditions (F n = 148, E n = 73, C n = 131). Several psychosocial constructs, including benefits of sun protection, susceptibility to and severity of photoaging and sun exposure, self-efficacy beliefs of making sun protection a daily habit, and barriers to sun protection were measured before and immediately following the intervention. Sun protection behavior was measured two weeks later. Those in the full intervention reported higher self-efficacy and severity of photoaging at immediate posttest than those in the efficacy only and control conditions. The fit of several path models was tested to explore underlying mechanisms by which the intervention affected sun protection behavior. Experienced emotion, specifically fear and disgust, predicted susceptibility and severity, which in turn predicted anticipated regret of failing to use sun protection. The relationship between this overall threat component (experienced emotion, susceptibility, severity, and anticipated regret) and intentions to engage in sun protection behavior was mediated by benefits. The present research provided evidence of the effectiveness of threat specific emotional arousal coupled with a self-efficacy and benefits message in interventions to increase sun protection. Further, this research provided additional support for the inclusion of both experienced and anticipated emotion in models of health behavior.