Predictors of Cervical Cancer Screening Awareness and Literacy Among Korean-American Women
Korean-American women experience a higher incidence of cervical cancer than non-Hispanic White women as well as other Asian-American women. A prominent cause of such a disproportional health risk among Korean-American women is a lack of awareness and knowledge of cervical cancer screening. Identifying factors related to cervical cancer screening awareness and literacy is critical for increasing cervical cancer screening among this population. Researchers surveyed 230 Korean-American women in a metro area in a Southeastern state, USA. Based on Anderson’s Behavioral Model of Health Services Use, predisposing, enabling, and need factors were explored to predict cervical cancer screening awareness and literacy. Monthly income, education, English proficiency, and annual checkups had significantly positive associations with cervical cancer screening awareness. Having an acquaintance giving support and receiving an annual checkup had significantly positive relationships with cervical cancer screening literacy. This study recommends culture specific guidelines to promote annual checkups through primary care physicians and the transfer of information about cervical cancer screening through acquaintances giving support.
Coping and culture: The protective effects of shift-&-persist and ethnic-racial identity on depressive symptoms in Latinx youth
Shift-&-persist is a coping strategy that has been shown to lead to positive health outcomes in low-SES youth but has not yet been examined with respect to psychological health. This study tests whether the shift-&-persist coping strategy works in tandem with ethnic-racial identity to protect against depressive symptoms in the face of two uncontrollable stressors: economic hardship and peer discrimination. In a sample of 175 Latinx youth (51.4% female; Mage = 12.9), shift-&-persist buffered the positive relation between economic hardship and depressive symptoms. In terms of peer discrimination, among youth who reported little use of shift and persist, discrimination was related to higher depressive symptoms, whereas youth who reported higher amounts of shift and persist (at and above the mean) were protected and did not evidence this association. However, among youth with high ethnic-racial identity, shift-&-persist failed to protect against the deleterious association between peer discrimination and depressive symptoms. These findings suggest that shift-&-persist is protective for Latinx youth, although the context in which it is protective changes based on the racialized/non-racialized nature of the stressor.
Child maltreatment in autism spectrum disorder and intellectual disability: results from a population-based sample
Children with developmental disabilities are at heightened risk for maltreatment. However, little is known regarding the prevalence of maltreatment among specific groups, such as autism spectrum disorder (ASD) and/or intellectual disability (ID). Information about maltreatment in these groups can aid in the development of supports and prevention strategies for vulnerable children and their families.Using record linkage between the Department of Social Services (DSS) and the Autism and Developmental Disabilities Monitoring (ADDM) network, this study compares the prevalence and characteristics of maltreatment among children with ASD-only (n = 316), ASD and comorbid ID (ASD+ID; n = 291), ID-only (n = 1,280), and controls (n = 3,101). Behavioral correlates of maltreatment are examined.Controlling for demographic factors, this study found significantly higher odds of reported and substantiated maltreatment among children with ASD-only (odds ratio = 1.86 for reported, 1.51 for substantiated), ASD+ID (odds ratio = 2.35 for reported, 1.97 for substantiated), and ID-only (odds ratio = 2.45 for reported, 2.49 for substantiated) relative to a population control group, with large effects. In particular, children with ASD+ID and ID-only were between two and three times more likely to experience maltreatment. All groups were more likely to experience physical neglect, and children in the ASD+ID and ID-only groups were more likely to experience all forms of abuse. Children in the ASD-only group were more likely to experience physical abuse. Maltreated children in the ASD-only and ID-only groups experienced more cases of physical abuse and neglect, and were victimized by more perpetrators compared to other maltreated youth. Maltreatment was associated with higher likelihood of aggression, hyperactivity, and tantrums for children with ASD.Children with ASD and/or ID are at heightened risk for maltreatment. Empirically-supported assessment and intervention approaches for identifying and addressing traumatic stress related to maltreatment in ASD are urgently needed.
Text messaging to engage friends/family in diabetes self-management support: acceptability and potential to address disparities
Explore acceptability of engaging family/friends in patients’ type 2 diabetes (T2D) self-management using text messaging. Participants (N = 123) recruited from primary care clinics for a larger trial evaluating mobile phone support for T2D completed self-report measures and a hemoglobin A1c test and then had the option to invite an adult support person to receive text messages. We examined characteristics and reasons of participants who did/did not invite a support person, responses to the invitation, and feedback from patients and support persons. Participants were 55.9 ± 10.1 years old, 55% female, 53% minority, and 54% disadvantaged (low income, less than high school degree/GED, uninsured, and/or homeless). Participants who invited a support person (48%) were slightly younger, more likely to be partnered, and reported more depressive symptoms and more emergency department visits in the year prior to study enrollment as compared to participants who did not (all p <.05). Participants’ reasons for inviting a support person included needing help and seeing benefits of engaging others, while reasons for not inviting a support person included concerns about being a “burden” and support person’s ability or desire to text. Support persons reported the texts increased awareness, created dialogue, and improved their own health behaviors. Patients inviting a support person had higher need and thus may stand to benefit most. Most support persons were open to engagement via text messages. Across race and socioeconomic status, text messaging may engage support persons to increase health-related support—particularly for patients with higher levels of need.
Social Work, Politics, and Social Policy Education: Applying a Multidimensional Framework of Power
The call to promote social justice sets the social work profession in a political context. In an effort to enhance social workers’ preparedness to engage in political advocacy, this article calls on educators to integrate a broad theoretical understanding of power into social policy curricula. We suggest the use of a multidimensional conceptualization of power that emphasizes mechanisms of decision making, agenda control, and attitude formation. We then apply these mechanisms to demonstrate how two prominent features of contemporary politics—party polarization and racially biased attitudes—affect the ability of social workers to influence policy. Finally, we suggest content that social work educators can integrate to prepare future social workers to engage in strategic and effective social justice advocacy.
Advanced Practice Registered Nurses’ Quality Improvement Efforts to Reduce Antipsychotic Use in Nursing Homes
Ethical Considerations in Chronic Brain Injury
A growing number of individuals are living with chronic traumatic brain injury. As these individuals and their families attempt to reintegrate into their communities, several ethical questions arise for clinicians and researchers. These include issues around alignment of perspectives and priorities, as well as responsibilities for ongoing treatment, education, community outreach, and research. An action plan for addressing these questions is outlined.
Disparities in Nursing Home Use and Quality Among African American, Hispanic, and White Medicare Residents With Alzheimer’s Disease and Related Dementias
This article examines differences in nursing home use and quality among Medicare beneficiaries, in both Medicare Advantage and fee-for-service, newly admitted to nursing homes with Alzheimer’s disease and related dementias (ADRD). Retrospective, national, population-based study of Medicare residents newly admitted to nursing homes with ADRD by race and ethnic group. Our analytic sample included 1,302,099 nursing home residents-268,181 with a diagnosis of ADRD-in 13,532 nursing homes from 2014. We found that a larger share of Hispanic Medicare residents that are admitted to nursing homes have ADRD compared with African American and White beneficiaries. Both Hispanics and African Americans with ADRD received care in segregated nursing homes with fewer resources and lower quality of care compared with White residents. These results have implications for targeted efforts to achieve health care equity and quality improvement efforts among nursing homes that serve minority patients.
Measuring success: Within and cross-domain predictors of academic and social trajectories in elementary school
Children’s skill levels in language, mathematics, literacy, self-regulation, and social–emotional adjustment at kindergarten entry are believed to play an important role in determining school success through their long-term association with academic and social skills in primary and secondary education. Hence, children’s school readiness is a national priority. To date, there is some evidence that specific individual school readiness skills relate to specific outcomes, but much of that research has not addressed concerns regarding generalization due to the high levels of correlations among the school readiness skills. The interrelationships among school readiness domains and patterns of skill acquisition – during the first three years of primary education in which basic skills are the focus and in the later years of primary or secondary education when higher-order skills are the focus – have not been explored adequately. Using the NICHD Study of Early Child Care and Youth Development dataset (n = 1364), this research conducted growth curve analyses to examine a comprehensive set of readiness indicators in kindergarten and identify which domains were stronger predictors of academic and social trajectories through grade 3 and from grades 3 to 5. Results highlight the importance of examining multiple school readiness domains simultaneously rather than separately, and moving beyond outcomes (skill levels) at a particular grade to consider which kindergarten skills predict gains over time (skill acquisition) both within- and across-domains. Empirical and methodological implications are considered for educational research, policy, and practice.
Association of body weight perception and unhealthy weight control behaviors in adolescence
The purpose of this article was to determine how body weight perception is related to weight control behaviors among a nationally representative sample of adolescents. Data came from the CDC’s nationally representative Youth Risk Behavior Surveillance System, 2013 (n = 13,857). Mean age was 16.2 years old. Multinomial logistic regressions were used to analyze the relationship between body weight perception (very underweight, slightly underweight, about the right weight, slightly overweight, and very overweight) and both unhealthy weight control behaviors individually (fasting, taking diet pills, and vomiting or taking laxatives) and any unhealthy weight control behavior, controlling for age, race/ethnicity, and BMI percentile and stratifying by gender. 13.35% of the sample reported fasting, 5.13% reported taking diet pills, and 4.20% reported vomiting or taking laxatives. Among girls, there was a significant positive association between feeling very underweight compared to about the right weight and all unhealthy weight control behaviors. In addition, feeling slightly overweight and very overweight increased the odds of fasting behavior or any unhealthy weight control behavior. Among boys, feeling very underweight, slightly overweight, and very overweight was associated with fasting, taking diet pills, vomiting or using laxatives, and any unhealthy weight control behavior. Both boys and girls engage in unhealthy weight control behaviors at a high rate, and the association with feeling under- and overweight overall increases the odds of these unhealthy behaviors. Health promotion efforts should focus on encouraging a healthy, normal body weight perception among adolescents in an effort to reduce unhealthy weight control behaviors.
Extending poly-victimization theory: Differential effects of adolescents’ experiences of victimization on substance use disorder diagnoses upon treatment entry
Although victimization is a known contributor to the development of substance use disorders, no research has simultaneously examined how characteristics of victimization experienced over time, such as the type of abuse, the presence of poly-victimization, closeness to perpetrator(s), life threat or fear, and negative social reactions to disclosing victimization, cluster into profiles that predict substance use disorders. The aim of the current study is to assess how profiles of victimization and trauma characteristics are associated with substance use disorders and assess potential gender differences. Participants were 20,092 adolescents entering substance use treatment. We used latent class and multi-group latent class analysis to extract classes of victimization and associated characteristics. Emergent classes were used to predicted substance use disorder status at treatment intake. Five classes were extracted: poly-victimization + high harmful trauma characteristics, sexual abuse + negative social reaction and perceived life threat, emotional abuse + trusted perpetrator, physical abuse and low all. Similar classes were found for the multi-group model. In both the overall and female-specific models, the poly-victimization + high harmful trauma characteristics class was more severe than all other classes in terms of opioid use disorder, tobacco use disorder, and dual diagnosis. Other class differences were found across gender. Adolescents entering treatment can be distinguished by their profiles of victimization experiences and associated characteristics, and these profiles evidence different associations with substance use disorder diagnoses. Results point to a need for more nuanced assessment of victimization experiences and gender-specific interventions.
Racial identity and racial attitudes among white Americans
Burden of hospitalizations over time with invasive aspergillosis in the United States, 2004–2013
Using aggregated data available on the interactive website from the Agency for Healthcare Research and Quality’s Healthcare Cost and Utilization Project Network (HCUPnet), we examined the annual volume of invasive aspergillosis (IA)-related hospitalizations in the US. This was a population study. Age-adjusted volumes were derived through population incidence calculated using year-specific censal and intercensal US population estimates available from the US Census Bureau. We additionally examined IA as the principal diagnosis and its associated outcomes in patients with ICD-9-CM codes 117.3, 117.9 and 484.6. The age-adjusted number of annual hospitalizations with IA grew from 35,968 cases in 2004 to 51,870 in 2013, a 44.2% overall increase, 4.4% per annum. Regionally, the South contributed the plurality of the cases (40%), and the Northeast the fewest (17%). While IA as principal diagnosis dropped, from 14.4 to 9.3%, mortality rose from 10 to 12%. Despite mean hospital length of stay decreasing from 13.3 (standard error [SE] 0.07) to 11.5 (SE 0.6) days, the corresponding mean hospital charges rose from $71,164 (SE $5248) to $123,005 (SE $9738). The aggregate US inflation-adjusted hospital charges for IA principal diagnosis rose from $436,074,445 in 2004 to $592,358,369 in 2013. Given the substantial volume and rate of growth in IA-related hospitalizations in the US between 2004 and 2013, an increase in mortality and high costs, IA may represent an attractive target for intensive preventive efforts.
Towards a Biopsychosocial Psychiatry
Objective: Constructing a meaningful biopsychosocial model for the mental health field has been extremely elusive. Identifying the linkages between the biological, psychological and social domains has been especially daunting. There has been important progress in clarifying general correlations of certain social factors related to the mental health of individuals and in developing training programs to recognize these social factors. However, efforts have usually focused on broad correlations and there have been serious deficiencies in developing methods for understanding and dealing with the specific processes happening at the psychological and social interface. For this reason, it would be important to be able to do such things as for example have a means to clarify the processes that connect the individual’s mental health and its specific interactions with his or her social class. In this report we suggest two approaches that can contribute to solving this problem. Methods: We will describe approaches from the fields of anthropology and microhistory that link the specific experiences of the individual and the nature of the social context in which he or she finds him/herself. Results: Careful application of certain anthropological and history study methods that “take seriously” the specific interactions between the environmental situation and the individual can provide approaches to improved understanding of the relevant variables and the causal links between “psycho” and “social” in the biopsychosocial model. Conclusions: Teaching and applying these principles in treatment and research can contribute to a more effective model of biopsychosocial interactions in the mental health field.
Standardizing Biases: Selection Devices and the Quantification of Race
Racial inequality persists despite major advances in formal, legal equality. Scholars and policymakers argue that individual biases (both explicit and implicit) combine with subjective organizational decision-making practices to perpetuate racial inequality. The standardization of decision making offers a potential solution, promising to eliminate the subjectivity that biases consequential decisions. We ask, under what conditions may standardization reduce racial inequality? Drawing on research in science studies and law and society, we argue that standardization must be understood as a heterogeneous practice capable of producing very different outcomes depending on the details of the standard and the organizational infrastructure surrounding its use. We compare selection devices—simple quantified tools for making allocation decisions—in undergraduate admissions and child welfare to highlight the complex relationships between race and standardization. Child welfare agencies adopted a colorblind actuarial device that attempted to predict which children were most at risk and then make decisions based on those predictions. In contrast, the University of Michigan’s points system explicitly considered and valued race, with the goal of increasing minority student enrollments in the context of promoting student body diversity. Comparing these cases demonstrates how actuarial standardization practices, including those adopted with the intention of reducing racial inequality, tend to reinforce an unequal status quo by ideologically reconfiguring mutable social structures into immutable individual risk factors. In contrast, nonactuarial practices that explicitly promote racial equality are vulnerable to political challenges as they violate norms of colorblindness and cannot be defended in terms of their predictive validity.
MindStrong and Emerge Models: Multidisciplinary, Feasible, Effective, and Sustainable
Compared to younger youth and middle-aged and older adults, older youth and young adults (16–25 year olds) are more likely to experience serious mental health challenges, including schizophrenia, bipolar, and major depressive disorders.1 These young people are at increased risk for high school dropout (or “pushout”), unemployment and under-employment, poverty, housing instability, homelessness, justice involvement, and suicide.2 They are also least likely to utilize mental health services, which tend to feel stigmatizing, incongruent, and ineffective to young people. Accessible, attractive, and effective services spanning both child and adult sectors are needed to engage this unique population. To address these challenges, Thresholds, the largest community mental health provider in Illinois, successfully developed and implemented two multidisciplinary sister teams serving young people within a Medicaid and commercial fee-for-service insurance billing environment.
Is TANF Truly Accessible and Helpful? Victims’ Experiences With Domestic Violence Screening Under the Family Violence Option
This study explores the experiences of domestic violence victims with their Temporary Assistance for Needy Families (TANF) applications and the subsequent assessment processes in the state of Georgia, focusing on the conditions related to their disclosure of abuse and their postdisclosure experiences. This study interviewed five victims of domestic violence, four local victim advocates, and three nationally recognized experts regarding domestic violence screening in TANF programs using semistructured interviews. Data were analyzed using grounded theory techniques. The findings showed that the participants perceived TANF application and assessment processes as (i) inaccessible and (ii) unhelpful, lacking special considerations for domestic violence victims. Conditions related to victims’ disclosure of abuse included (i) safety concerns, (ii) working relationships between local victim support agencies and TANF offices, (iii) a safe environment to disclose abuse, and (iv) advocacy. After disclosing their domestic violence history to their TANF caseworkers, the victims reported experiencing (i) a lack of continued assessment and support related to domestic violence and (ii) a compulsion to make final decisions regarding continuing or discontinuing their TANF applications. The current study contributes to the field of social work by providing a better understanding of how and to what extent victims of domestic violence are actually supported within the TANF system and by yielding practice and policy implications for effectively assisting the victims of domestic violence within the TANF system.
Visualizing Perceived Enablers of and Barriers to Healthy Eating by Youth in Rural El Salvador
Objective: To explore the perceived environmental enablers for and barriers to healthy eating among rural Salvadoran youth. Methods: A photovoice activity was implemented at a grade school located in a rural region of northeastern El Salvador. Results: Nine female and 8 male youth aged 8–12 years participated. A total of 116 photos were generated for thematic analysis. Photos and descriptions from youth revealed an overall theme of ambiguity in healthy eating across multiple environments. This theme of ambiguity was interwoven throughout 2 subthemes: (1) links between food and health, and (2) the juxtaposition of globalized foodscapes and natural resources. Conclusions and Implications: Photos and descriptions from youth illustrated the murky distinctions between healthful and less healthful foods embedded within daily encounters across multiple environments. To further an understanding of factors that promote or hinder healthy eating in youth, future research might incorporate methods that capture the ways in which youth conceptualize healthy eating, as well as their contributions to healthy eating.
On the fringes: How youth experiencing homelessness conceptualize social and economic inequality–A Photovoice study
This study used Photovoice methods with young adults experiencing homelessness to collaboratively identify issues that are of greatest importance in an open‐ended, exploratory, and inductive manner. Participants selected two concepts to focus their inquiry: freedom and prosperity. Within these concepts, participants discussed nature as a source of inspiration, a desire to better themselves and to change their situations, and passion for contributing to social change by exposing economic inequality and raising awareness about homelessness. These findings demonstrate that young people are keenly aware of the structural and macro‐level factors that have contributed to their risks of social exclusion and marginalization.
Community-based participatory design for research that impacts the lives of transgender and/or gender-diverse autistic and/or neurodiverse people
Objective: Research addressing the co-occurrence of autism (and/or neurodiversity) and gender-diversity (A/ND-GD) has been conducted largely without the perspectives and voices of the A/ND-GD community. Including A/ND-GD community advocates as research partners may be a critical next step for advancing research initiatives on the co-occurrence given the apparent complexity and alterity of the A/ND-GD experience. Method: Consistent with the community-based participatory research (CBPR) model we propose herein, our authorship team includes a partnership between clinician researchers and diverse A/ND-GD community collaborators. Multiple facets of the A/ND-GD lived experience are examined, including through narratives provided by our A/ND-GD community partners. Results: Based on our experience conducting A/ND-GD-related research and our lived experience as A/ND-GD self-advocates, we highlight challenges in this line of research, including risks of conducting studies without the involvement of the A/ND-GD community. And given that many A/ND-GD youth present with gender-related urgency during the teen years, we provide a developmental framework for how CBPR-informed methods may enrich our understanding of the care needs of these young people and provide context for the apparent heterogeneity in their gender needs and trajectories over time. Conclusions: Integrating CBPR methodologies in A/ND-GD research initiatives has the potential to optimize the relevance of the research questions asked and the interpretation and contextualization of study findings.