Perceptions of belongingness and social support attenuate PTSD symptom severity among firefighters: A multistudy investigation

Florida State University

Firefighters experience high rates of posttraumatic stress disorder (PTSD). It is imperative to identify malleable factors that protect against the development of PTSD symptoms among this population. We examined whether perceptions of belongingness broadly (Study 1) and social support from supervisors, coworkers, and family/friends specifically (Study 2) are associated with lower PTSD symptom severity among firefighters. Study 1 included 840 U.S. firefighters (91.1% male); participants completed the Interpersonal Needs Questionnaire and PTSD Checklist—Civilian Version. Study 2 included 200 U.S. women firefighters exposed to a Criterion A traumatic event; participants completed the Generic Job Stress Questionnaire, Life Events Checklist for Diagnostic and Statistical Manual of Mental Disorders–5, and PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders–5. Linear regression analyses were conducted, adjusting for the number of years participants served as firefighters. Greater belongingness broadly (Study 1; b = −0.740, p < .001) as well as social support specifically (Study 2) from supervisors (b = −4.615, p < .001), coworkers (b = −4.465, p = .001), and family/friends (b = −3.206, p = .021) were associated with less severe PTSD symptoms. When all sources of social support were entered into a single model, only support from supervisors was significantly associated with lower overall PTSD symptom severity (b = −4.222, p = .004). Belongingness and social support may protect against the development of PTSD among firefighters. Supervisor social support may be particularly salubrious, suggesting that top-down mental wellness promotion within the fire service may be indicated to protect firefighters against PTSD.

Publication
Psychological Services
Publication Year
2019

Preferences for Communicating about Breast Cancer Screening Among Racially/Ethnically Diverse Older Women

University of Houston

Differences exist across breast cancer screening guidelines regarding frequency of screening and age of discontinuation for older women (≥70 years) at average risk for breast cancer. These differences highlight concerns about the benefits and harms of screening, and may negatively impact older women’s ability to make informed screening decisions. This study examined preferences for communicating about screening mammography among racially/ethnically diverse, older women. In-depth interviews were conducted with 59 women with no breast cancer history. Non-proportional quota sampling ensured roughly equal numbers on age (70–74 years, ≥75 years), race/ethnicity (non-Hispanic/Latina White, non-Hispanic/Latina Black, Hispanic/Latina), and education (≤high school diploma, >high school diploma). Interviews were audio-recorded, transcribed, and analyzed using NVivo 10. Thematic analyses revealed that rather than being told to get mammograms, participants wanted to hear about the benefits and harms of screening mammography, including overdiagnosis. Participants recommended that this information be communicated via physicians or other healthcare providers, included in brochures/pamphlets, and presented outside of clinical settings (e.g., in senior groups). Results were consistent regardless of participants’ age, race/ethnicity, or education. Findings revealed that older women desire information about the benefits and harms of screening mammography, and would prefer to learn this information through discussions with healthcare providers and multiple other formats.

Publication
Health Communication
Publication Year
2019

Examining How Factors Associated with Patients, Physicians, Hospitals, and Surrounding Communities Affect Primary and Repeat Cesarean Delivery Through a Social-Ecological Lens

City University of New York School of Public Health

Childbirth is one of the most common reasons for hospitalization in the U.S., and Cesarean delivery (i.e., surgical childbirth) is costlier and has a higher likelihood of birth-related complications, maternal rehospitalization, and postpartum medical care utilization than vaginal delivery. The rate of Cesarean delivery in the United States (U.S.) has increased in recent years by over 60%, from 20.7% of all births in 1996 to 32.9% of all births in 2011. As Although this increasing trend of Cesarean delivery incidence has also been seen in other countries, the rate of Cesarean delivery has been rising more steadily within the U.S. than nearly anywhere else. While Cesarean delivery has been established as the safer delivery option for women with certain high-risk pregnancy complications that could put mother and/or baby in danger during vaginal delivery, the increasing rate of Cesarean delivery in the U.S. has not been accompanied with a concomitant decrease in maternal and neonatal morbidity and mortality. Therefore, it has been suggested that at least some Cesarean deliveries performed may be clinically unnecessary, and may put pregnant women at an avoidable higher risk of adverse health outcomes. Numerous factors across multiple levels of organization have been linked to influencing the likelihood of a pregnant woman receiving a Cesarean delivery. Firstly, a robust body of evidence has linked numerous clinical facets of pregnancy, either related to maternal health specifically (e.g., gestational diabetes) or fetal health presentations (e.g., fetal malpresentation), to increased Cesarean delivery likelihood. Additionally, certain sociodemographic characteristics, such as being of older age or being of black/African-American race, have been linked to a higher risk of having a Cesarean delivery. Numerous factors beyond the pregnant woman herself, however, have also been linked to the likelihood of a Cesarean delivery occurring, through a social-ecological framework. Practice-related (e.g., clinical experience, medical school location) and sociodemographic characteristics (e.g., age, gender) of the physician presiding over the birth have been shown to affect Cesarean delivery occurrence. Furthermore, aspects of the hospital where the birth occurs related to maternity health-related practices (e.g., vaginal birth after Cesarean occurrence) and ownership/affiliation (e.g., teaching status, private ownership) have been associated with influencing Cesarean delivery likelihood in numerous studies. Lastly, while there is a dearth of information as to how the health of communities where pregnant women live specifically affect Cesarean delivery likelihood, the sociodemographic profile of communities have been linked to other adverse pregnancy outcomes (e.g., preterm birth, low birthweight). As such, this dissertation research examined: 1) the role of sociodemographic and maternal health-related characteristics of communities related to overall and maternal health characterize in influencing Cesarean delivery incidence across ZIP codes in New York State (NYS); 2) how characteristics associated with pregnant women, physicians, hospitals and patient residential communities affect primary Cesarean delivery risk in pregnant women in NYS; and, 3) how the factors aforementioned in step 2 above affect repeat Cesarean delivery risk in pregnant women in NYS.

Publication
Cuny Academic Works
Publication Year
2019

Characteristics of Patients that Substitute Medical Cannabis for Alcohol

Geisinger Commonwealth School of Medicine

A substitution effect with medical cannabis replacing prescription opioids has been reported but less is known for alcohol. This study evaluated characteristics which might differentiate alcohol substituters (N=47) from non-substituters (N=65) among dispensary members. Substituters were significantly more likely to be employed and have more health conditions than non-substituters.

Publication
MedRxiv
Publication Year
2019

Age-related differences in the structural and effective connectivity of cognitive control: a combined fMRI and DTI study of mental arithmetic

Johns Hopkins University

Cognitive changes with aging are highly variable across individuals. This study investigated whether cognitive control performance might depend on preservation of structural and effective connectivity in older individuals. Specifically, we tested inhibition following working memory (WM) updating and maintenance. We analyzed diffusion tensor imaging and functional magnetic resonance imaging data in thirty-four young adults and thirty-four older adults, who performed an arithmetic verification task during functional magnetic resonance imaging. Results revealed larger arithmetic interference in older adults relative to young adults after WM updating, whereas both groups showed similar interference after WM maintenance. In both groups, arithmetic interference was associated with larger activations and stronger effective connectivity among bilateral anterior cingulate, bilateral inferior frontal gyrus, and left angular gyrus, with larger activations of frontal regions in older adults than in younger adults. In older adults, preservation of frontoparietal structural microstructure, especially involving the inferior frontaloccipital fasciculus, was associated with reduced interference, and stronger task-related effective connectivity. These results highlight how both structural and functional changes in the cognitive control network contribute to individual variability in performance during aging.

Publication
Neurobiology of Aging
Publication Year
2019

Child, Family, and Case Characteristics Associated With Reentry Into Out-of-Home Care Among Children and Youth Involved With Child Protection Services

University of Denver

Many children and youth with child protection services (CPS) involvement enter out-of-home care. The aims of this study were to examine rates of reentry and risk factors associated with reentry into out-of-home care among children and youth involved in the child protection (reported for abuse/neglect) and youth-in-conflict (reported for behavioral issues) programs. This study used administrative data from Colorado’s Statewide Automated Child Welfare Information System, which contains information on all children and youth who enter Colorado’s CPS. Of the 14,461 children and youth in the child protection program and 2,353 children and youth in the youth-in-conflict program, 14.7% and 35.1%, respectively, reentered into out-of-home care. Families’ prior history of CPS involvement and current CPS case characteristics better explained reentry into out-of-home care than child and family demographic characteristics alone. Understanding risk factors associated with reentry into out-of-home care is critical to inform the prevention of child maltreatment recurrence and ensure the safety, permanency, and well-being of children and youth.

Publication
Child Maltreatment
Publication Year
2019

Family-based activity settings of children in a low-income African context

Indiana University

Background: There has been an overwhelming call to improve the understanding of how children develop within an African context as Euro-American definitions of competence have been uncritically adopted as the norm for children in Africa. The activities that children engage in within the family setting are seen as important to understand how children develop within context. The use of activity settings is closely aligned with a strengths-based perspective of family-centred practice and contributes to improved sustainability of intervention. Objectives: This study that was conducted in Soweto, South Africa, aims to describe activity settings that typically developing young children in low-income African contexts participate in. Method: A descriptive design using structured interviews was utilised to obtain information about activity settings that children aged 3–5 years and 11 months engaged in. Structured interviews with 90 caregivers were conducted. Results: Findings show that children participate in a variety of activities with varied participation levels. The types of activities are dependent on the context and perceptions of caregivers. Conclusion: These findings draw attention to understanding activities that children engage in within the family context.

Publication
African Journal of Disability
Publication Year
2019

Missed Appointments by Hypertension Patients in Transitional Care: Race and Insurance Correlates

Florida State University

Missed outpatient appointments represent a barrier to continuity of care. Little evidence exists on the relationship between health insurance status and missed appointments at a transitional care clinic (TCC) for underserved hypertensive patients. High blood pressure is the leading risk factor for stroke. This study examined associations between payment status and race with missed first appointments after discharge following hypertension-based hospitalization. We conducted a retrospective study using an appointment database during the first three years at a TCC that serves underserved patients. Nearly two-thirds of eligible patients (n=144) self-identified as Blacks. Three types of insurance and demographics were used to predict the missed first appointment in three two-step logistic regression models. We also examined the interaction between race and appointment status. The role of race in appointment status varied across three models. Privately insured patients had fewer missed appointments. However, the interaction analyses showed that privately insured Black patients were more likely to miss their first appointments than patients of other races or patients with other insurance types. Black patients without insurance were more likely to appear at appointments, though neither being publicly insured nor being uninsured was independently related to missed appointments. Further investigation into vulnerable populations should address mechanisms underlying these relationships.

Publication
Journal of Public Health Issues and Practices
Publication Year
2019

A comparison of patients managed in specialist versus non-specialist inpatient rehabilitation units in Australia

University of Texas, Austin

To compare the rehabilitation of patients with brain and spinal cord injury in specialist rehabilitation units and non-specialist rehabilitation units in Australia over a 10-year period. A retrospective cohort study design was used. Epidemiological descriptive analysis was used to examine inpatient rehabilitation data held in the Australasian Rehabilitation Outcomes Centre Registry Database at four discrete time points: 2007, 2010, 2013 and 2016. Data sets included patient demographics, length of stay and the Functional Independence Measure. Data sets were examined for differences between specialist and non-specialist rehabilitation units. Over the 10-year study period, compared to patients admitted to non-specialist rehabilitation units patients admitted to specialist rehabilitation units: (1) were younger and more likely to be male; (2) had a longer time between onset of illness/injury and rehabilitation admission; (3) had a longer median rehabilitation length of stay; (4) had a higher burden of care on admission to rehabilitation; however (5) had a greater functional gain. Patients in specialist rehabilitation units had a lower relative functional efficiency per day of rehabilitation, but higher percentage of Functional Independence Measure gain. In 2016, 66% of brain injury and 51% of spinal cord injury patients were not rehabilitated in specialist rehabilitation units.There are differences in the characteristics of patients admitted to specialist versus non-specialist rehabilitation units. Patients admitted to specialist rehabilitation units have greater functional gain. A noteworthy proportion of brain and spinal cord injury patients are not being rehabilitated in specialist rehabilitation units, particularly patients with non-traumatic injuries.

Publication
Disability and Rehabilitation
Publication Year
2019

The resilience of indigenous women of the U.S. who experience cancer: transcending adversity

University of Iowa

Almost no research specifically explores resilience among Indigenous women of the U.S. who experience cancer. A qualitative descriptive study included a sample of 43 Indigenous women from the Northern Plains region of the U.S. Almost 90% (88%, n = 37) of participants indicated personal growth in response to having cancer, indicating they valued relationships (n = 3), had a stronger faith (n = 5), were grateful and living in moment (n = 21), became more healthy (n = 5), and helped others (n = 6) in response to their cancer experience. Results indicate that factors that promote and facilitate resilience are critical for culturally responsive practice with Indigenous women.

Publication
Journal of Ethnic & Cultural Diversity in Social Work
Publication Year
2019

What’s Race Got to Do With It? Racial Socialization’s Contribution to Black Adolescent Coping

University of North Carolina at Chapel Hill

While youth generally experience stressors from developmental milestones, Black youth also face racialized stressors. Racial socialization has been found to help Black youth cope with racialized stressors, but research has yet to show its contribution to coping beyond general socialization practices. This study examines how racial socialization contributes beyond that of general coping socialization to coping behaviors. Fifty-eight third-eighth-grade (Mage = 11.3, SD = 1.54) youth reported general coping socialization and racial socialization practices and coping behaviors. Results indicate that for engagement coping, racial socialization messages contributed significantly to parent-provided engaged socialization strategies. Implications are considered for the ways in which Black youth experience stress and require culturally specific practices for successful coping with frequently encountered stressors.

Publication
Journal of Adolescent Research
Publication Year
2019

Preschool to Third Grade Alignment: What Do We Know and What Are We Learning? Policy Brief

New York University

An investment in early childhood education pays off when the benefits continue into adulthood. Although many recent preschool interventions have had positive, short-term effects on young children’s language, literacy, mathematics, executive function, and social-emotional development, studies show that related gains in cognitive and academic skills tend to diminish in early elementary school — a phenomenon commonly known as fade-out. Instructional alignment — or implementing educational systems that effectively build on the learning advances made in preschool — is one of the leading strategies for sustaining the benefits of early childhood education. This brief further examines the concept of instructional alignment and its potential for upholding the longer-term advantages of preschool programs. This paper looks specifically at two projects that MDRC is using to study the effects of instructional alignment on classrooms and students — the Making PreK Count/High 5s and ExCEL P3 projects. The brief summarizes the latest results from these projects and identifies how future work that is driven by MDRC’s studies can inform educational research, policy, and practice.

Publication
MDRC
Publication Year
2019

Sex and substances: Does body image play a role?

The University of Kansas

Having sex under the influence of alcohol and/or drugs places individuals at high risk for STI transmission and unplanned pregnancy. Although the relationship between body image and sexual behavior has been well established, research on the relationship between body image and sexual behavior under the influence among adolescents is scant. The purpose of this study is to investigate the relationship between body image and unprotected sex and unprotected sex while under the influence among adolescents. We conducted logistic regression analyses using data from the Oregon Youth Substance Use Project (N = 937). Measures included body image, unprotected sex, unprotected sex while inebriated, age, sex, and BMI. Body image was not related to unprotected sex, but was significantly related to unprotected sex while inebriated in the past year and in their lifetime (OR = 2.17, 2.33). Results suggest substance use may be important to the relationship between body image and sexual behavior among adolescents. Additional research is warranted to inform future interventions.

Publication
Journal of Substance Use
Publication Year
2019

Mental health service use decision-making among young adults at clinical high risk for developing psychosis

New York University

Aim: Research has shown that young adults at clinical high risk (CHR) for developing psychosis have the capability to recognize that they have a problem and initiate mental health services, yet there is a paucity of theoretically based research examining this decision-making process. This is critical to study because there are high rates of underutilization of mental health services among these young people. The following study explored the decision-making process among young adults at CHR in order to understand mental health services utilization at a CHR clinic. Methods: Semi-structured face-to-face interviews were conducted with 30 young adults at CHR between the ages of 18 and 30, from an Eastern city in the United States. The study applied the unified theory of behaviour (UTB), a decision-making framework for health behaviour, to examine service use. Content analysis with multiple coders was used. Results: The most salient constructs discussed when participants envisioned seeking services at the clinic included attitudes or beliefs about help-seeking, social image beliefs and emotional reactions towards seeking services. Differences in UTB responses emerged depending on whether participants were engaged in clinical services and research at the time of the interview or just taking part in research follow-ups. Conclusion: When designing future interventions to increase service utilization among young adults at CHR, programs can address health beliefs such as how services at the clinic can improve symptoms, stigma and difficult emotions such as fear and shame about seeking services, and particularly among young people who are more ambivalent about seeking clinical services.

Publication
Early Intervention in Psychiatry
Publication Year
2019

“It’s All about Breaking down Those Barriers…”: Exploring Survivors’ Perspectives on Services and Treatment Needs following Commercial Sexual Exploitation during Childhood

The University of North Carolina at Chapel Hill

Purpose: In recent years, there has been an increase in funds and services available to address the needs of commercially sexually exploited children (CSEC). While previous studies have explored the mental, behavioral, and physical needs of CSEC victims and survivors, few studies have focused on the service needs CSEC victims and survivors themselves deem most important. The current study seeks to bridge this gap by garnering American CSEC victims’ and survivors’ perspectives regarding CSEC service strengths, weaknesses, and gaps. Method: Semi-structured, in-depth interviews were conducted with 13 adult survivors of CSEC to examine their perceptions of current CSEC services in the United States. All interviews were recorded, transcribed verbatim, and imported into a qualitative data analysis program. Using an inductive approach, two major themes emerged: short-term needs and long-term needs. Results: Short-term needs included victim identification, housing, and emergency medical care. Long-term needs included life-skills, community building, legal assistance, and medical care. The results point to the complex needs of CSEC victims/survivors. Discussion: While CSEC services continue to develop, there remain many gaps in care in the services available. Study findings provide valuable insight to practitioners and researchers alike and identify the most critical needs of CSEC victims and survivors. Implications for practice and research are discussed.

Publication
Journal of Evidence-Based Social Work
Publication Year
2019

Relationships of Reproductive Coercion and Intimate Partner Violence to Unintended Pregnancy

Johns Hopkins School of Nursing

Setting: Six participating states contributed data from the Pregnancy Risk Assessment Monitoring System (PRAMS). Participants: Data were obtained for 20,252 women who gave birth between 2012 and 2015 and completed the PRAMS survey within 9 months of giving birth. Methods: Weighted descriptive statistics and multivariate logistic regression models were used to assess the influence of RC and IPV on odds of UIP. Results: Approximately 2.7% (n = 600) of participants reported physical IPV, and 1.1% (n = 285) reported RC. Participants less than 30 years of age, with low socioeconomic status, who were single and of Black or Hispanic race/ethnicity were at significantly increased risk of IPV. With the exception of Hispanic race/ethnicity, these sociodemographic characteristics were also associated with an increased risk for RC. Participants who experienced IPV had a nearly eightfold increased risk of RC (adjusted odds ratio = 7.98, 95% confidence interval [CI] [4.68, 13.59]) than their nonabused counterparts. In univariate models, RC, IPV, or RC with IPV were significantly associated with increased odds of UIP (odds ratio [OR] = 2.18, 95% CI [1.38, 3.44]; OR = 2.36, 95% CI [1.75, 3.19]; OR = 3.55, 95% CI [1.56, 8.06], respectively); however, results were nonsignificant after adjusting for sociodemographic factors. Conclusion: In this population-based sample, we confirmed that there were links among IPV, RC, and UIP, all factors associated with poor maternal and infant outcomes. Screening for IPV and RC is an important step toward reducing rates of UIP.

Publication
Journal of Obstetric, Gynecologic & Neonatal Nursing
Publication Year
2019

Using the Consolidated Framework for Implementation Research to examine implementation determinants of specialty mental health probation

University of North Carolina at Chapel Hill

Background: Specialty mental health probation (SMHP) is designed to improve outcomes for the large number of people with serious mental illnesses who are on probation and/or parole. The evidence for specialty mental health probation is promising; however, little is known about the implementation challenges and facilitators associated with SMHP. To address this gap, we used the consolidated framework for implementation research (CFIR) to analyze 26 interviews with stakeholders representing multiple agencies involved in the implementation of SMHP. Results: Results indicate a number of challenges and facilitators related to the inner setting, outer setting, implementation process, and characteristics of individuals. Conclusions: Findings suggest that complex and cross-sectoral interventions are context-dependent and introduce a number of challenges and facilitators related to multiple CFIR domains. Consequently, agency administrators implementing these types of interventions should consider small pilot studies and develop implementation strategies tailored to the local implementation context.

Publication
Health & Justice
Publication Year
2019

Experiences and Needs of Older Adults Following Hurricane Ike: A Pilot Study of Long-Term Consequences

University of Houston

This study explored the experiences and needs of older adults during and following Hurricane Ike. Two focus group interviews were conducted among older adults who lived in or around Galveston Island before Hurricane Ike. Nine older adults (six women and three men) participated in two focus group sessions. These qualitative interviews were audio recorded, transcribed, and analyzed using thematic content analyses. The findings of this study reveal the need for continuity in health care services, medications, psychological support, social and family support, community-level services, and information among older adults. The contribution of factors such as health care continuity and psychological support reinforces the importance of specific postdisaster resources to meet the needs of older adults following hurricanes. These results suggest the importance of designing hurricane preparedness guidelines specifically for older adults.

Publication
Health Promotion Practice
Publication Year
2019

Self-Competence and Depressive Symptoms in Middle-Late Adolescence: Disentangling the Direction of Effect

Department of Psychological Sciences

This study examined the temporal relation between self-competence (academic, social, athletic, physical appearance, and close friend) and depressive symptoms in a large, diverse community sample of 636 adolescents. Surveys were administered to all 10th- and 11th-grade students at participating high schools at baseline (mean age = 16.10, SD = .71) and 1 year later. Girls reported higher levels of self-competence in close friendships and more depressive symptoms, whereas boys reported higher levels of self-competence in athletics and physical appearance. However, there were no gender differences in the associations between self-competence and depressive symptoms. Results from autoregressive, cross-lagged path analyses indicated that depressive symptoms predicted self-competence more consistently than self-competence predicted depressive symptoms during middle-late adolescence. Implications for prevention are discussed.

Publication
Journal of Adolescent Research
Publication Year
2019

Standing on the Shoulders of Giants: Matthew O. Howard as a Mentor and His Influence on the Science of Mindfulness as a Treatment for Addiction

University of Utah

It is difficult to estimate the impact of a scholar. Conventional metrics such as citation counts, h-indexes, publications in top-tier journals, and federal grants all provide some objective indication of scholarly impact, but these indices fail to capture the holistic and historical context of a scholar’s influence on the development and emergence of entirefields of inquiry. To obtain a more comprehensive sense of scholarly impact, a reviewer with close knowledge of both the scholar and the field is required. As his student and colleague, I believe that Matthew Owen Howard, PhD, exerted a singular influence on social work research, and his scholarly efforts helped give rise to a new and critically important field of scientific investigation: the study of mindfulness as a treatment for addiction.

Publication
Journal of the Society for Social Work and Research
Publication Year
2019