Perceived Discrimination as a Mediator of ACEs and Psychological Distress
The authors investigated the role of perceived discrimination in the association between adverse childhood experiences and psychological distress in adulthood in a sample of individuals (n = 125) at a university-based couple and family therapy clinic. Results showed that a majority had experienced four or more adverse experiences, indicating a high risk of negative health outcomes. A significant indirect effect of adverse experiences through perceived discrimination on psychological distress, even with gender, race/ethnicity, and household income as covariates, was noted. Findings underscore the importance of incorporating assessment of perceived discrimination in therapy with clients presenting with childhood adversity and psychological distress.
The role of maternal psychosocial perceptions in parent-training programs: a preliminary randomized controlled trial
Parent-child interaction is critical for early language and literacy development. Parent training programs have proliferated to support early interactions. However, many environmental and psychosocial factors can impact the quality of parent-child language and literacy interactions as well as training program outcomes. This preliminary randomized controlled trial examined maternal perceived self-efficacy and locus of control during a language and literacy parent training program. Thirty mother-child dyads (mother age 21-40; children 2;6-4;0) were assigned in parallel to the training or control group. The training was efficacious for mothers and children – training-group dyads made significantly greater gains in maternal strategy use, responsivity, and child print awareness than the control group. Gains were maintained one month post-training. Children whose mothers had more external baseline control perceptions identified significantly fewer print targets at baseline and made greater gains than those with more internal control perceptions. Future directions and implications are discussed.
Inequality in Isolation:: Educating Students with Disabilities during COVID-19
Effects of homophobic name‐calling and verbal sexual harassment on substance use among young adults
Verbal aggression victimization, such as homophobic name‐calling, has been linked to heavier substance use among young people, but little longitudinal research has examined how different types of victimization may affect substance use or whether certain psychosocial factors moderate these risks. In a diverse cohort (N = 2,663), latent transition analysis was used to model heterogeneity in victimization (age 19) and substance use (age 20). Four victimization (high victimization, homophobic name‐calling only, verbal sexual harassment only, and low victimization) and three substance use (poly‐substance use, alcohol, and cannabis only, low all) classes were identified. The high victimization and homophobic name‐calling only classes had the highest probabilities of transitioning into the poly‐substance use class, and the high victimization class had the highest probability of transitioning into the alcohol and cannabis only class. The probability of transitioning into the low all substance use class was highest in the low victimization class and lowest in the high victimization class. For the high victimization class, greater depressive symptoms increased the odds, and better peer relationship quality decreased the odds, of transitioning into the poly‐substance use and alcohol and cannabis only classes. For the homophobic name‐calling only class, greater depressive symptoms increased the odds of transitioning into the poly‐substance use class. Homophobic name‐calling, alone or in combination with verbal sexual harassment, is a risk factor for escalating substance use in young adulthood, especially among victims with depressive symptoms.
Defining Patient Engagement in Research: Results of a Systematic Review and Analysis: Report of the ISPOR Patient-Centered Special Interest Group
Objectives: Lack of clarity on the definition of “patient engagement” has been highlighted as a barrier to fully implementing patient engagement in research. This study identified themes within existing definitions related to patient engagement and proposes a consensus definition of “patient engagement in research.” Methods: A systematic review was conducted to identify definitions of patient engagement and related terms in published literature (2006-2018). Definitions were extracted and qualitatively analyzed to identify themes and characteristics. A multistakeholder approach, including academia, industry, and patient representation, was taken at all stages. A proposed definition is offered based on a synthesis of the findings. Results: Of 1821 abstracts identified and screened for eligibility, 317 were selected for full-text review. Of these, 169 articles met inclusion criteria, from which 244 distinct definitions were extracted for analysis. The most frequently defined terms were: “patient-centered” (30.5%), “patient engagement” (15.5%), and “patient participation” (13.4%). The majority of definitions were specific to the healthcare delivery setting (70.5%); 11.9% were specific to research. Among the definitions of “patient engagement,” the most common themes were “active process,” “patient involvement,” and “patient as participant.” In the research setting, the top themes were “patient as partner,” “patient involvement,” and “active process”; these did not appear in the top 3 themes of nonresearch definitions. Conclusion: Distinct themes are associated with the term “patient engagement” and with engagement in the “research” setting. Based on an analysis of existing literature and review by patient, industry, and academic stakeholders, we propose a scalable consensus definition of “patient engagement in research.”
Psychometric properties of a measure to assess beliefs about modifiable behavior and emotional distress
Assessing beliefs about the helpfulness of modifiable behaviors related to mental health could inform public health efforts to prevent emotional distress. This study examined the psychometric properties of a measure to assess beliefs about the helpfulness of modifiable behaviors involved in the development of anxiety and depression. The relationship between beliefs about modifiable behaviors and actual engagement in modifiable behaviors was also examined. Item pool generation was based on a review of the literature. Experts (N = 10) and participants (N = 50) reviewed the items for content validity. An exploratory factor analysis was conducted on the resultant Beliefs about Behaviors and Emotional Distress Scale (BBEDS) for item reduction in a sample of MTurk participants (Study 1, N = 371). A confirmatory factor analysis was completed in a second MTurk sample (Study 2, N = 373). Construct validity was then examined in a sample of college students (Study 3, N = 215). The questionnaire included 16 items across four domains: health behavior (0.77 ≤ α ≤ 0.84), social support (0.72 ≤ α ≤ 0.76), substance use (0.75 ≤ α ≤ 0.76), and avoidance (0.81 ≤ α ≤ 0.83). The BBEDS had adequate psychometric properties supporting its use to assess beliefs about the helpfulness of modifiable behaviors related to the development of emotional distress. BBEDS scores were associated with engaging in some but not all modifiable behaviors. The BBEDS may be a useful instrument to assess beliefs about the helpfulness of modifiable behaviors implicated in the development of anxiety and depression.
Dignity at the end of life
Debt, Incarceration, and Re-entry: a Scoping Review
People involved with the criminal justice system in the United States are disproportionately low-income and indebted. The experience of incarceration intensifies financial hardship, including through worsening debt. Little is known about how people who are incarcerated and their families are impacted by debt and how it affects their reentry experience. We conducted a scoping review to identify what is known about the debt burden on those who have been incarcerated and their families and how this impacts their lives. We searched 14 data bases from 1990 to 2019 for all original research addressing financial debt held by those incarcerated in the United States, and screened articles for relevance and extracted data from pertinent studies. These 31 studies selected for inclusion showed that this population is heavily burdened by debt that was accumulated in three general categories: debt directly from criminal justice involvement such as LFOs, preexisting debt that compounded during incarceration, and debts accrued during reentry for everyday survival. Debt was generally shown to have a negative effect on financial well-being, reentry, family structure, and mental health. Debts from LFOs and child support is very common among the justice-involved population and are largely unpayable. Other forms of debt likely to burden this population remain largely understudied. Extensive reform is necessary to lessen the burden of debt on the criminal justice population in order to improve reentry outcomes and quality of life.
Literacy of Breast Cancer and Screening Guideline in an Immigrant Group: Importance of Health Accessibility
Little is known about predictors of breast cancer literacy among immigrant women. A cross-sectional survey investigated predisposing, enabling, and need factors of breast cancer literacy among 233 Korean American women living in a southeastern U.S. city. Breast cancer literacy was measured by questions that asked awareness of cancer screening methods and a 5-item questionnaire derived from the American Cancer Society’s breast cancer screening guidelines and risk factors. Annual checkup was an enabling factor of awareness of Clinical Breast Exam (CBE) and mammogram, and also for breast cancer literacy covering the knowledge of breast cancer screening guidelines and risk factors. Health status was a need factor of CBE awareness. Marital status was a predisposing factor of mammogram awareness, and age and years of residence in the US were predisposing factors of breast cancer literacy. The findings of the study illuminate probable avenues of intervention to promote breast health knowledge for Korean American women.
Financial Instability in the Earned Income Tax Credit Program: Can Advanced Periodic Payments Ameliorate Systemic Stressors?
The Earned Income Tax Credit (EITC) serves more than 26 million U.S. tax filers every year. The EITC is distributed annually at tax time; however, past research suggests that lump-sum disbursements leave households with a lack of funds to deal with financial emergencies throughout the year. Drawing upon the data from a pilot program conducted in 2014–2015 in Chicago, this study analyzes how advanced periodic payments help mitigate financial instability for EITC recipients. Interview participants relate that advanced periodic payments result in a reduction in perceived stress, lower levels of debt, fewer unpaid bills, and the ability to engage youth in extracurricular activities. The findings provide a unique perspective on the ways in which low-income households cope with financial instability and stress and suggest that payment frequency options can play a small but important role in the way in which the EITC operates as a support mechanism.
Institutional capacity to provide psychosocial care in cancer programs: Addressing barriers to delivering quality cancer care
This study investigates barriers and promoters to delivering quality psychosocial services in 58 cancer programs across North America. Oncology care providers (n = 2008) participated in a survey in which they identified barriers and promoters for delivering psychosocial care at their respective institutions. Multilevel modeling was used to examine (a) the extent to which provider and institutional characteristics were associated with the most common barriers, and (b) associations between perceived barriers and institutional capacity to deliver psychosocial services as measured by the Cancer Psychosocial Care Matrix. Across 58 Commission on Cancer‐accredited programs in North America, the most frequently reported barriers were inadequate number of psychosocial care personnel, lack of funding, inadequate amount of time, lack of systematic procedures, and inadequate training for oncology providers. Overall, there were few significant differences in reported barriers by type of institution or type of provider. In general, the most frequently reported barriers were significantly associated with the institution’s capacity to deliver quality psychosocial care. In particular, the lack of a systematic process for psychosocial care delivery significantly predicted lower levels of institutional capacity to deliver quality psychosocial care. When identifying barriers, respondents reported a greater number of institutional barriers than barriers related to individual provider or patient characteristics. These results present a compelling case for cancer programs to implement and monitor systematic procedures for psychosocial care and to integrate these procedures in routine clinical practice.
Can Precision Medicine Actually Help People Like Me? African American and Hispanic Perspectives on the Benefits and Barriers of Precision Medicine
To better understand African American and Hispanic perspectives on the potential benefits of precision medicine, along with the potential barriers that may prevent precision medicine from being equally beneficial to all. We also sought to identify if there were differences between African American and Hispanic perspectives. Six semi-structured focus groups were conducted between May 2017 and February 2018 to identify benefits and barriers to precision medicine. Three groups occurred in Nashville, TN with African American participants and three groups occurred in Miami, FL with Hispanic participants. At community-based and university sites convenient to community partners and participants. A total of 55 individuals participated (27 in Nashville, 28 in Miami). The majority of participants were women (76.5%) and the mean age of participants was 56.2 years old. Both African Americans and Hispanics believed precision medicine has the potential to improve medicine and health outcomes by individualizing care and decreasing medical uncertainty. However, both groups were concerned that inadequacies in health care institutions and socioeconomic barriers would prevent their communities from receiving the full benefits of precision medicine. African Americans were also concerned that the genetic and non-genetic personal information revealed through precision medicine would make African Americans further vulnerable to provider racism and discrimination in and outside of health care. While these groups believed precision medicine might yield benefits for health outcomes, they are also skeptical about whether African Americans and Hispanics would actually benefit from precision medicine given current structural limitations and disparities in health care access and quality.
The role of elementary school and home quality in supporting sustained effects of pre-K
Using data from the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development (NICHD SECCYD), we used 2-level random effects models to examine whether the quality of school and home environments during elementary school moderated associations between pre-K quality and math, reading, and vocabulary achievement from first through fifth grade. Results showed that the quality of the home environment moderated the association between pre-K quality and children’s vocabulary achievement. Supportive home environments during elementary school had an additive effect over and above the positive effects of pre-K quality in predicting children’s vocabulary achievement. In contrast, when children experienced high levels of pre-K quality and lower quality home learning environments, the positive effects of pre-K were less likely to be sustained. Findings suggest the importance of considering programs and policies to support home-based learning as one potential mechanism to sustain early effects of pre-K.
Cognitive behavioral intervention for trauma in adolescent girls in child welfare: A randomized controlled trial
Objective This study tested the effectiveness of Cognitive Behavioral Intervention for Trauma in Schools (CBITS) in adolescent girls involved in the child welfare system. Three outcomes were evaluated: symptoms of posttraumatic stress disorder (PTSD), depression, and social problem-solving skills. Method A randomized controlled trial was utilized to compare the effects of an adapted version of CBITS with usual care (UC) services. Participants were ages 12 to 19 (N = 249), the majority of whom (69.5%) were African American. Participants’ symptoms of PTSD, depression, and social problem-solving skills were evaluated at pre, post (3 months), and follow-up (6 months) assessments. Linear mixed models were used to compare condition by time interactions using all available data. Control variables were demographics, service use, and number of types of traumas. Treatment fidelity, participant acceptability, and satisfaction with the intervention were also examined. Results Analyses indicated that participants in the CBITS condition showed significantly greater increases in social problem-solving than the UC condition. For both PTSD and depression symptoms, there were no significant differences between the two conditions. Both the CBITS and UC participants showed significant reductions in symptoms. Results also indicated that this intervention is an acceptable model for this population. Conclusions Despite the growth of trauma-focused, evidence-supported interventions for reducing PTSD and depression, knowledge of effective interventions in child welfare youth lags behind. Because CBITS is more effective than UC in increasing social problem-solving skills, this intervention may be an important treatment option for this population.
Co-occurring risk factors among U.S. high school students at risk for suicidal thoughts and behaviors
Background: Suicidal thoughts and behaviors (STBs) are increasing among adolescents in the United States and are challenging to predict and prevent. The current study identifies subtypes of youth at risk for suicidal thoughts and behaviors (STBs) in school-based settings. Method: Data are from the CDC’s 2015 and 2017 National Youth Risk Behavior Survey of US high school students. Among students reporting depression symptoms, latent class analysis is used to identify subtypes at risk for STBs based on personal characteristics, risk behaviors and environments. Results: Two distinct subtypes of youth were found to be at high risk for STBs: The first, larger subtype (22%) is predominately females in early high school, many of whom identify as bisexual, experienced past-year bullying, and are likely to have experienced sexual victimization. These students have low levels of externalizing risk behaviors making them difficult to detect. The second high-risk subtype (7%) is characterized by students with significant social integration challenges, with extremely high levels of substance abuse, fighting, physical and sexual victimization and poor academic performance. Many of these students have low English fluency, and identify as sexual minority. Limitations: Due to attrition or language barriers, experiences of some students at high-risk for STBs may not have been captured by this survey. Conclusion: Universal screening in clinical settings, and universally focused suicide prevention programs in school-based settings are needed and should be introduced early on. Interventions should be tailored to reach high-risk students with language, cultural and social integration challenges.
Utilizing Crisis Intervention Teams in Prison to Improve Officer Knowledge, Stigmatizing Attitudes, and Perception of Response Options
People with mental illness (MI) are overrepresented in prisons, in part, because people with MI stay in prison longer. Correctional officers (COs) use discretion in force, violations, and segregation. Crisis intervention teams (CITs) are being used in corrections to reduce disparities in sanctioning and improve safety. This quasi-experimental, mixed-methods study includes 235 CIT COs who were surveyed before and after training on knowledge of MI, stigmatizing attitudes, and perception of response options. Non-CIT (n = 599) officers completed the same survey. Randomly selected CIT COs completed interviews 6 to 9 months following training (n = 17). CIT COs had significantly lower stigmatizing attitudes, more mental health knowledge, and better perceptions of options following CIT training compared with non-CIT COs. This preliminary work on CIT use in prison is promising; additional work is needed to determine whether these changes result in behavior change among COs and improvements in outcomes for people with MI.
Characterizing the predictive validity of measures of susceptibility to future use of combustible, vaporized and edible cannabis products in adolescent never-users
Background and aims: The construct of susceptibility to substance use initiation (i.e. cognitive proclivity to future use) is critical for prevention efforts in adolescent populations. This study aimed to provide empirical evidence for the validity of the susceptibility construct for different cannabis products (i.e. combustible, edible or vaporized cannabis), and evaluate whether susceptibility measures are predictive of subsequent initiation. Design: Prospective cohort study including baseline data (Spring 2015) and four follow-up surveys administered every 6 months through Spring 2017. Setting: Ten schools in the Los Angeles, California metropolitan area. Participants: Adolescents [n = 2100; mean age = 16.1; standard deviation (SD) = 0.41; 54% female] who reported never having used any cannabis product at baseline.Measurements: We assessed five indices of a susceptibility to use cannabis composite index at baseline, adapted from a validated tobacco use index (intention to use, willingness, curiosity and positive/negative cannabis use outcome expectancies, with four response categories, definitely not  to definitely yes ), by cannabis product (combustible, edible or vaporized). A composite index was created for each product by averaging responses across the five susceptibility items. Subsequent initiation of use of each cannabis product was assessed at each follow-up wave. Findings: Factorial validity for unidimensionality for each five-item index (by product) was confirmed. The composite index for susceptibility to cannabis use was greatest for combustible (mean = 1.44; SD = 0.58), moderate for edible (mean = 1.37; SD = 0.53) and lowest for vaporized cannabis (mean = 1.30; SD = 0.44). The associations of each composite susceptibility index with subsequent initiation of that product and each of the other cannabis products over follow-up (i.e. cross-product associations) were statistically significant, with hazard ratios ranging from 2.30 to 2.80 across 24 months of follow-up (all Ps < 0.05). Conclusions: A five-item susceptibility to cannabis use composite index (by product) appears to be useful for characterizing and predicting youth at risk for cannabis use initiation across a spectrum of cannabis products.
Collective Threat: Conceptualizing Blumer’s Threat as a Collective Emotion
This manuscript lays the groundwork for considering racial threat as a collective emotion. Although sociologists regularly study racial threat, a disconnect exists between Blumer’s theoretical framework (1958) and modern empirical measurement. Research has largely measured racial threat as perceptions of competition or increases in racism. Neither, however, squarely fits the symbolic interactionist framework that Blumer championed. This manuscript frames racial threat as an affective group response that is generated through sustained interaction with social groups and group representations. After showing how Blumer’s threat conceptualization fits the parameters of a collective emotion, I demonstrate how quantitative measurement and experimental research design can be used to capture threat as Blumer outlines it. Then, using factor analyses and regression, I illustrate that collective threat is distinct from other collective emotions and operates according to Blumer’s theoretical predictions. The manuscript concludes with a discussion of how ongoing attempts to measure collective threat and the evolution of racism in the United States highlight the continued relevance of Blumer’s work.
Putting Quality Metrics in Context: A Novel Index Approach to Measuring Inpatient Utilization
To determine the preliminary feasibility and reliability of a novel health plan‐level quality index reflecting multiple aspects of inpatient utilization currently measured by separate quality metrics. Analysis of three Healthcare Effectiveness Data and Information Set (HEDIS) measures: Acute Hospital Utilization (AHU), Hospitalizations for Potentially Preventable Conditions (HPC), and Plan All‐Cause Readmissions (PCR). Proportion of plans able to report these measures were examined within and between measurement years. Individual measure performance was scored on the observed‐to‐expected (O/E) ratio: O/E = 1 “as expected” (score of 0), O/E < 1 “better than expected” (score of +1), and O/E > 1 “worse than expected” (score of ‐1). Measure scores were summed to create an index (‐3 to +3). Performance variation was examined. Index unidimensionality and reliability were evaluated using coefficient omega (total and hierarchical) and explained common variance (ECV). Medicare Advantage (MA) plans reporting HEDIS in measurement years (MY) 2017 (505 plans) and 2018 (525 plans). To align reporting strata across the three metrics, analysis was restricted to beneficiaries age 65 and older. A majority of plans were able to report measures in both MY2017 and MY2018 (AHU: 67.0%, HPC: 65.7%, PCR: 60.7%). In MY2018, 71.4% of plans reported all three measures. The strongest correlation in O/E ratios was observed between AHU and HPC (Pearson: 0.29, Spearman: 0.64), the weakest between AHU and PCR (Pearson: 0.19, Spearman: 0.17). A moderate correlation was observed between PCR and HPC (Pearson: 0.31, Spearman: 0.36). “Better than expected” (+1) was the most common measure‐level score on AHU (48.0%) and HPC (51.4%). “As expected” (0) was the most common score (58.5%) on PCR. The most common index score was +2 (25.1%), and mean score was 0.3. HPC performance scores were most likely to contribute to an increased index score (52.4% of cases), and AHU performance was most likely to contribute to a decreased index score (42.1% of cases). PCR performance was as likely to increase (20.5%) as decrease (21.1%) the index score. When the original O/E ratio for each measure was retained, moderate‐to‐good reliability was observed. Omega hierarchical approached the minimum 0.50 threshold (0.49), and ECV met the 0.85 threshold for unidimensionality. Omega hierarchical decreased significantly (0.33), and ECV no longer achieved the 0.85 threshold when the composite was scored as an ordinal index (‐3 to +3). A composite inpatient utilization index is feasible and demonstrates meaningful variation. Index‐style scoring is useful for visualization and identification of trends; however, composite reliability is achieved only when original O/E ratios are maintained. Alternative scoring approaches should be examined. Inpatient utilization is a primary driver of health care costs and critical target for quality improvement. Current health plan accountability metrics focus on different components of utilization separately and may miss the relationships between them. Interventions to improve one metric may overlap into another, while over‐focusing on one aspect in isolation may lead to perverse incentives (eg, keeping total hospitalizations high to make readmission rates appear low). The proposed composite approach provides a more complete representation of inpatient care, improving transparency and accountability.
The Influence of Implicit Theories of Depression on Treatment-Relevant Attitudes
Implicit theories (beliefs about the malleability of self-relevant traits) of emotion are associated with various motivational and emotional responses. Less is known about implicit theories of depression. The present study examined the effects of a manipulation of implicit theories of depression on depression symptom severity, engagement in a self-help task, and treatment-relevant attitudes. Participants experiencing clinically significant levels of depression (N = 142) were randomly assigned to receive education about depression emphasizing either the malleability of depression (incremental condition) or depression as a chronic condition (entity condition). Participants subsequently completed a self-help task for depression. Symptom severity, stigma, prognostic pessimism, psychotherapy and antidepressant credibility, psychological flexibility, and time spent on the self-help task were assessed. Participants in the incremental condition endorsed a greater incremental theory of depression than did those in the entity condition. To the extent that the experimental condition was associated with the adoption of an incremental theory of depression, depression symptom severity and stigma decreased, and treatment-relevant attitudes were more favorable. The experimental condition had no effect on self-help task persistence. Presenting depression as malleable may be associated with more positive attitudes towards treatment, although the impact on actual treatment engagement warrants future investigation.