Publications

The tragic killing of Michael Brown on August 9, 2014, at the hand of Darren Wilson, a Ferguson, Missouri, police officer, further highlighted the long-standing disparities in health, education, employment, and overall well-being disproportionately burdening Black boys and young men in the St. Louis region (city and county). Since Brown’s death, we have observed a continuous environment of civil unrest and weakened confidence in the region’s welfare and economic future. An examination of reports and media discussions following the incidents in Ferguson reveal actions that have rightly centered on attending to structural determinants, racism, and equity (U.S. Department of Justice, 2015). Notably absent, however, was a central focus on the economic opportunity and overall well-being of Black boys and young men in the St. Louis region.

This paper provides a methodological description of a multi-site, randomized controlled trial (RCT) of a cognitive-behavioral intervention for enhancing employment success among unemployed persons whose employment efforts have been undermined by social anxiety disorder (SAD). SAD is a common and impairing condition, with negative impacts on occupational functioning. In response to these documented employment-related impairments, in a previous project, we produced and tested an eight-session work-related group cognitive-behavioral therapy provided alongside vocational services as usual (WCBT + VSAU). WCBT is delivered by vocational service professionals and is designed in a context and style that overcomes accessibility and stigma-related obstacles with special focus on employment-related targets. Our previous project found that WCBT + VSAU significantly improved social anxiety, depression, and a range of employment-related outcomes compared to a control group of socially anxious job-seekers who received vocational services as usual without WCBT (VSAU-alone). Participants in this study were all homeless, primarily African American job-seekers with high levels of psychiatric comorbidity and limited education and employment histories. The present, two-region study addresses whether WCBT + VSAU enhances job placement, job retention and mental health outcomes in a larger sample assessed over an extended follow-up period. In addition, this trial evaluates whether the effects of WCBT + VSAU generalize to a new population of urban-based, racially diverse job-seekers with vocational and educational histories that differ from our original sample. This study also investigates the system-effects of WCBT + VSAU in a new site that will be informative for broad implementation of WCBT + VSAU. Finally, this project involves a refined, technology-assisted form of WCBT + VSAU designed to be delivered more easily by vocational services professionals.

Attention and working memory (WM) have previously been shown to interact closely when sensory information is being maintained. However, when non-sensory information is maintained in WM, the relationship between WM and sensory attention may be less strong. In the current study, we used electroencephalography to evaluate whether value-driven attentional capture (i.e., allocation of attention to a task-irrelevant feature previously associated with a reward) and its effects on either sensory or non-sensory WM performance might be greater than the effects of salient, non-reward-associated stimuli. In a training phase, 19 participants learned to associate a color with reward. Then, participants were presented with squares and encoded their locations into WM. Participants were instructed to convert the spatial locations either to another type of sensory representation or to an abstract, relational type of representation. During the WM delay period, task-irrelevant distractors, either previously-rewarded or non-rewarded, were presented, with a novel color distractor in the other hemifield. The results revealed lower alpha power and larger N2pc amplitude over posterior electrode sides contralateral to the previously rewarded color, compared to ipsilateral. These effects were mainly found during relational WM, compared to sensory WM, and only for the previously rewarded distractor color, compared to a previous non-rewarded target color or novel color. These effects were associated with modulations of WM performance. These results appear to reflect less capture of attention during maintenance of specific location information, and suggest that value-driven attentional capture can be mitigated as a function of the type of information maintained in WM.

For hourly workers, schedule predictability often depends on how far in advance schedules are posted. This article presents results from a process evaluation of an intervention to increase advance schedule notice in hourly retail jobs. The authors open up the black box of implementation to understand managers’ experiences posting schedules further in advance and employees’ ability to anticipate working time. Although schedules were posted further in advance in treatment than control stores, the intervention did not improve schedule anticipation. The findings demonstrate the value of attending to the “dual agenda” of assessing workplace interventions from the perspective of both employers and employees.

Anxiety is an under-investigated comorbidity in heart disease patients. Optimism/hope is a character strength that indicates confidence or favorable expectation about the future. Previous research has consistently reported optimal health outcomes among optimists. However, many studies have lacked adjustment for medical confounders and/or used small clinical samples. To bridge this gap, we tested the hypothesis that optimism/hope was inversely related to anxiety in 400+ patients with advanced heart disease during the stressful waiting period prior to open-heart surgery. The findings supported the hypothesis after controlling for general health, illness impact, behavioral risks, and cardiac medical indices used by surgeons.

Cancer is the leading cause of death among American Indian and Alaska Native (AIAN) women, and depressive symptoms have been linked to higher mortality, but research on depressive symptoms among AIAN cancer patients has been scant. The purpose of this exploratory study was, using the Framework of Historical Oppression, Resilience, and Transcendence, to examine risk and protective factors related to depressive symptoms in American Indian (AI) women cancer survivors. We examined the relationships of adverse childhood experiences (ACE), perceived health status, resilience, and social support with depressive symptoms in Northern Plains AI women cancer survivors. We used a cross-sectional design with purposive sampling of 73 female cancer survivors (aged 18 years or older) between June 2014 and February 2015. Hierarchical multiple regression was used to test three sets of variables in relation to depressive symptoms: (1) sociodemographics, (2) risk factors (ACE and perceived health), and (3) protective factors (psychological resilience and social support). Approximately 47 percent of participants had probable depressive symptoms. Depressive symptoms were inversely associated with perceived health, psychological resilience, and social support. These results support bolstering existing social support among AI cancer patients and survivors as well as prevention and intervention efforts that strengthen resilience.

We evaluated the Fatal Encounters (FE) database as an open-source surveillance system for tracking police-related deaths (PRDs). We compared the coverage of FE data to several known government sources of police-related deaths and police homicide data. We also replicated incident selection from a recent review of the National Violent Death Reporting System. FE collected data on n = 23,578 PRDs from 2000–2017. A pilot study and ongoing data integration suggest greater coverage than extant data sets. Advantages of the FE data include circumstance of death specificity, incident geo-locations, identification of involved police-agencies, and near immediate availability of data. Disadvantages include a high rate of missingness for decedent race/ethnicity, potentially higher rates of missing incidents in older data, and the exclusion of more comprehensive police use-of-force and nonlethal use-of-force data—a critique applicable to all extant data sets. FE is the largest collection of PRDs in the United States and remains as the most likely source for historical trend comparisons and police-department level analyses of the causes of PRDs.

This post is one in a series highlighting MDRC’s methodological work. Contributors discuss the refinement and practical use of research methods being employed across our organization.

Community-based hybrid nonprofits, defined as organizations that combine social services with organizing or advocacy, play a crucial role at the neighborhood level. Considering their nonconformity to conventional organizational forms, they face specific challenges and advantages in achieving their combined advocacy and service mission. Using neo-institutional theory to provide context to our data, this qualitative study of 18 nonprofits working in one neighborhood examines how hybrid nonprofits are categorized as well as processes for legitimacy for these organizations. We find that at the neighborhood level, hybrid nonprofits are identified as “grassroots” by both hybrids and non-hybrids alike and draw on this “grassroots” identity to achieve legitimacy. We examine the settings for this “grassroots” legitimacy and its challenges and conditions. Through cultivating a better understanding of community-based hybrid nonprofits, this study adds to the literature on how nonprofits provide services and organize at the neighborhood level.

Drawing on interviews and ethnographic observation, this article examines how poor African American mothers in Houston, Texas, experience seeking help from the safety net, focusing on mothers’ perceptions and interpretation of the application process. Compared to welfare, seeking help from nonprofits and churches involved little formal surveillance and there was no punitive mechanism involved if mothers did not adhere to the minimal conditions required for participation. Mothers framed this as a preferable option to welfare, which they characterized as intrusive and punitive. However, the absence of formal surveillance practices in nonprofits did not mitigate the need to discern between the deserving and undeserving poor, nor did it ameliorate women’s sense of stigma around seeking help. Mothers were thus ambivalent about utilizing these resources. Further, it was mothers, not welfare caseworkers, who sometimes took on a surveilling role in these settings, scrutinizing themselves and other women and distancing themselves from those they deemed as undeserving. By taking up the same cultural logics of deservingness produced through welfare surveillance and applying them elsewhere, mothers were able to shore up their own sense of personhood and moral worthiness in an environment that threatened both. Yet, the strategies mothers used to distance themselves from others they cast as undeserving may unintentionally reproduce the notion that poor people must be scrutinized when seeking assistance. This logic reinforces the rationale for the surveillance mothers lament and resist in the welfare system.

Objective: Research has shown that young adults at clinical high risk (CHR) for developing psychosis have difficulties seeking, accessing, and staying engaged with mental health services. The present study explored perspectives on engagement with mental health services among young adults at CHR. Method: In-depth interviews were conducted with 30 participants at CHR, ages 18-30, from an Eastern U.S. state. Grounded theory methodology was used to analyzed qualitative data. Results: Six major categories emerged from the data reflecting participants’ perspectives of engagement with services. Contextual factors such as social, community, and online networks mattered to young adults, and individual factors such as level of awareness, stigma, emotions, and environmental factors emerged as critical. These factors suggested a conceptual model of service utilization among young adults at clinical high risk for developing psychosis that builds upon and extends existing conceptual frameworks of service use among young adults. Conclusion and Implications for Practice: A conceptual model of service utilization among young adults at CHR emerged from that data that can inform interventions aimed at improving engagement in services and reduce the amount of time young adults at CHR remain untreated for emerging psychological problems. Furthermore, this study highlights the unique contribution of mental health service use messages received from online networks and a possible relationship between hierarchical stigma and service use.

Domestic minor sex trafficking (DMST) is one of the most prevalent yet hidden forms of child abuse in the United States. DMST victims are diverse in age, race, and socioeconomic status. Many DMST victims are involved in state-level systems including the child welfare and/or juvenile justice system. State-level systems are federally mandated to identify children who are at risk or survivors of DMST. Unfortunately, DMST victim/survivor identification is inconsistent and often ineffective and is based on service providers’ and DMST victims’/survivors’ de facto definitions of DMST. This study presents exploratory, qualitative findings regarding service provider and DMST victim/survivor de facto definitions of DMST. In addition, it explores how these definitions are different from and/or similar to extant federal and state legal definitions. Content analysis revealed three key qualitative themes, including force/fraud/coercion, commercialization, and DMST as a form of child sexual abuse. Importantly, DMST victim/survivor and service provider definitions of DMST are different, which may be contributing to ineffective DMST victim/survivor identification protocols. Furthermore, there are several important differences between participants’ definitions of DMST and extant federal and state legal definitions. Implications for policy and practice are discussed.

Unwanted sexual incidents on university campuses pose significant public health and safety risks for students. This study explored survivors’ perspectives on secondary prevention of campus sexual assault and effective strategies for intervention programs for unwanted sexual incidents in university settings. Twenty-seven student survivors of unwanted sexual experiences participated in semi-structured in-depth interviews. Data were analyzed using thematic analysis and a constructionist perspective. The findings were contextualized using the ecological model. Barriers to reporting included concerns about one’s story not being believed, personal minimization of the incident, belief that no action will be taken after reporting, confidentiality concerns, and other perceived costs of reporting. Survivors provided valuable insight on potentially effective prevention and intervention strategies to address the problem of unwanted sexual incidents on university campuses. These findings may be useful for prevention and intervention policies and programs in university settings and for providers who assist survivors of unwanted sexual experiences.

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.

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.

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.

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.

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.

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.

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.