Dimensions of acculturative stress and their implications for school belonging and achievement were examined among 199 Latino middle-school students. The proposed model hypothesized that school belonging would mediate the association between acculturative stress dimensions and low school achievement. Eighty percent youth of the sample were immigrants, 73% had Mexican origins, 57% were girls, and the mean age of the participants was 13.6 years. A factor analysis yielded two dimensions of acculturative stress: discrimination stress and immigration-related stress. Immigration-related stress was associated with age of immigration, but discrimination stress was not. Findings supported the hypothesis that lack of school belonging may be a mechanism by which discrimination stress, but not immigration-related stress, decreases school performance among Latino youth.

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To determine the effects of gamification on student education, researchers implemented "Kaizen," a software-based knowledge competition, among a first-year class of undergraduate nursing students. Multiple-choice questions were released weekly or biweekly during two rounds of play. Participation was voluntary, and students could play the game using any Web-enabled device. Analyses of data generated from the game included (1) descriptive, (2) logistic regression modeling of factors associated with user attrition, (3) generalized linear mixed model for retention of knowledge, and (4) analysis of variance of final examination performance by play styles. Researchers found a statistically significant increase in the odds of a correct response (odds ratio, 1.8; 95% confidence interval, 1.0-3.4) for a round 1 question repeated in round 2, suggesting retention of knowledge. They also found statistically significant differences in final examination performance among different play styles.To maximize the benefits of gamification, researchers must use the resulting data both to power educational analytics and to inform nurse educators how to enhance student engagement, knowledge retention, and academic performance.

Background Little is known about diet quality with a reduced-energy, low-fat, partial meal replacement (PMR) plan, especially in individuals with type 2 diabetes. The Action for Health in Diabetes (Look AHEAD) trial implemented a PMR plan in the intensive lifestyle intervention (ILI). Objective Compare dietary intake and percent meeting fat-related and food group dietary recommendations in ILI and diabetes support and education (DSE) groups at 12 months. Design Randomized controlled trial, comparing ILI to DSE, at 0- and 12-months. Participants/setting From 16 United States sites, the first 50% of participants (aged 45 to 76 years, overweight or obese, with type 2 diabetes) were invited to complete dietary assessments. Complete 0- and 12-month dietary assessments (collected between 2001 and 2004) were available on 2,397 participants (46.6% of total participants), with 1,186 randomized to DSE and 1,211 randomized to ILI. Main outcome measures A food frequency questionnaire assessed intake: energy; percent energy from protein, fat, carbohydrate, polyunsaturated fatty acids (PUFA), and saturated fats; trans fatty acids; cholesterol; fiber; weekly meal replacements (MRs); and daily servings from food groups from the Food Guide Pyramid. Statistical analyses performed Mixed-factor analyses of covariance (ANCOVA), using Proc MIXED with a repeated statement, with age, sex, race/ethnicity, education, and income controlled. Unadjusted chi-square tests compared percent meeting fat-related and food group recommendations at 12 months. Results At 12 months, ILI had a significantly lower fat and cholesterol intake and greater fiber intake than DSE. ILI consumed more servings/day of fruits; vegetables; and milk, yogurt & cheese; and fewer servings/day of fats, oils & sweets than DSE. A greater percentage of ILI than DSE participants met fat-related and most food group recommendations. Within ILI, a greater percentage of participants consuming ≥ 2 MRs/day than < 1 MR/day met most fat-related and food group recommendations. Conclusions The PMR plan consumed by ILI was related to superior diet quality.

Background: Nursing faculty sought to promote students' engagement with course material and their peers by using Kaizen, an online educational game. The purpose of this qualitative study was to learn more about nursing students' perceptions of team competition in an educational game and whether the game promoted their engagement with educational material in one fundamental nursing course. Method: Qualitative data collection included focus groups, observations of students, documents showing leaderboards and game participation, and “status of competition” e-mails. Data were transcribed and coded to determine emerging themes. Results: Four themes emerged from data analysis: learning in teams, motivators to play, learning course content, and suggestions for game improvement. Conclusion: Students were overwhelmingly positive about using a gamified platform for its educational rewards. They perceived that playing the game increased their knowledge retention, and they believed it helped them improve their test-taking skills. [ J Nurs Educ . 2019;58(2):79–85.]

Objective To identify baseline attributes associated with consecutively missed data collection visits during the first 48 months of Look AHEAD—a randomized, controlled trial in 5145 overweight/obese adults with type 2 diabetes designed to determine the long-term health benefits of weight loss achieved by lifestyle change. Design and Methods The analyzed sample consisted of 5016 participants who were alive at month 48 and enrolled at Look AHEAD sites. Demographic, baseline behavior, psychosocial factors, and treatment randomization were included as predictors of missed consecutive visits in proportional hazard models. Results In multivariate Cox proportional hazard models, baseline attributes of participants who missed consecutive visits (n=222) included: younger age ( Hazard Ratio [HR] 1.18 per 5 years younger; 95% Confidence Interval 1.05, 1.30), higher depression score (HR 1.04; 1.01, 1.06), non-married status (HR 1.37; 1.04, 1.82), never self-weighing prior to enrollment (HR 2.01; 1.25, 3.23), and randomization to minimal vs. intensive lifestyle intervention (HR 1.46; 1.11, 1.91). Conclusions Younger age, symptoms of depression, non-married status, never self-weighing, and randomization to minimal intervention were associated with a higher likelihood of missing consecutive data collection visits, even in a high-retention trial like Look AHEAD. Whether modifications to screening or retention efforts targeted to these attributes might enhance long-term retention in behavioral trials requires further investigation.

PurposeIn 1991, we described the recruitment and goals for a cohort of young adults. At the time, little was known about long-term retention of young, healthy and mobile adults or minorities. We present retention strategies and rates over 25 years, and predictors of participation at the year 25 follow-up examination of the Coronary Artery Risk Development in Young Adults (CARDIA) Study, a longitudinal investigation of coronary artery disease risk factors in a biracial population initially ages 18–30 years recruited from four U.S. centers in 1985.MethodsCARDIA has employed a range of strategies to enhance retention, including two contacts per year, multiple tracking methods to locate participants lost-to-follow-up, use of birthday and holiday cards, participant newsletters, examination scheduling accommodations and monetary reimbursements, and a standing committee whose primary purpose has been to continually review retention rates and strategies and identify problems and successes.ResultsFor 25 years, CARDIA has maintained >90% contact with participants between examinations, over 80% at any 2-year interval, and a 72% 25-year examination attendance rate. Baseline predictors of year 25 examination attendance include white race, female sex, older age, higher education, nonsmoking and moderate alcohol consumption.ConclusionConsistent use of multiple retention strategies, including attention to contact rates and sharing of best strategies across study centers, has resulted in high retention of a diverse, initially young, biracial cohort.

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