Navigating a Minefield, Meta-Synthesis of Teen Mothers’ Breastfeeding Experience
Teen mothers have lower rates of breastfeeding duration and exclusivity than older mothers. A growing body of qualitative research on teen mothers’ experience helps to explain these disparities. Following a systematic search to identify relevant research, we synthesized the findings from 22 primary studies to conclude that teen mothers navigate a minefield that undermines their intention to breastfeed and their breastfeeding confidence and skill. This metaphorical minefield reflects competing norms for infant feeding and good mothering, as evident in mixed support from teens’ social networks; fragmented and stigmatizing healthcare; and spaces that are inhospitable to teen mothers and breastfeeding mothers in general. In recognition of this minefield, we urge clinicians to: respect teen mothers’ infant feeding decisions; develop collaborative relationships based on the principles of patient-centered and strength-based care; challenge stigmatizing healthcare practices; welcome teen mothers and their significant others to clinical settings; and press health systems to fully implement probreastfeeding policies. We also recommend further study to extend our knowledge about teen mothers’ breastfeeding experiences.
Coping Behaviors Mediate Associations between Occupational Factors and Compassion Satisfaction among the Intimate Partner Violence and Sexual Assault Workforce
The intimate partner violence (IPV) and sexual assault (SA) workforce faces significant occupational stressors yet little is known about positive occupational outcomes associated with this work. Therefore, this study analyzed factors associated with compassion satisfaction among the IPV/SA workforce in one southwestern U.S. state (n = 623). Drawing from the Resilience Portfolio Model (Grych et al. 2015), researchers examined the possible role of coping behaviors in mediating associations between compassion satisfaction and workplace resources / assets, perceived job security, and resilience. Analyses revealed partial mediation in the models that included workload, values, and resilience as independent variables, suggesting that these factors both influence workers’ coping behaviors and have an independent association with compassion satisfaction. Models investigating control, rewards, community, fairness, and perceived job security indicated significant total effects of the independent variables on compassion satisfaction. Overall, IPV/SA workers who engaged more frequently in a range of coping behaviors reported higher levels of compassion satisfaction. The findings point to implications for organizational and employee practice, including building in worktime for key individual coping behaviors, balancing workloads among staff members, and enhancing organizational level coping strategies, such as team supervision and team care planning.
Addressing the physician-scientist pipeline: Strategies to integrate research into clinical training programs
Introduction Physician-scientists are critical members of the biomedical workforce. Thecombination of rigorous scientific training and clinical skills uniquely positions them tobridge clinical needs with investigational pursuits by identifying important clinical questionsthat drive basic discoveries and translating those into therapeutics that improve patientoutcomes. The impact of physician-scientists on biomedical science has been profound.Indeed, the recipients of the 2019 Nobel Prize in Physiology or Medicine, William Kaelin Jr.,Gregg Semenza, and Peter Ratcliffe, are all physician-scientists. Furthermore, physician-scientists have been well represented as Nobel laureates (including Frederick Banting, CarlCori, Earl Sutherland, Alfred Gilman, Michael Brown, Joseph Goldstein, Bernardo Houssay,Edwin Krebs, Peter Agre, Harold Varmus, Robert Lefkowitz, Brian Kobilka, and RalphSteinman, to name a few). Yet, as the need for novel therapies has grown, the number ofphysician-scientists has declined (1). The reasons for this decline are numerous, includinglength and cost of clinical training, declining funding opportunities, reduced visibility ofphysician-scientist role models, and compensation disparities between academic andprivate practice careers. Residency, fellowship training, and entry into faculty — importantentry points for budding physician-scientists and a period of continuity for those who wish tobuild on their earlier research experiences — are critical junctures where attrition occursalong the physician-scientist training timeline (2–5).
Young transgender women survivors of intimate partner violence: A latent class analysis of protective processes
COVID-19 cases and testing in 53 prison systems
COVID-19 has entered United States prison systems at alarming rates. Disparities in social and structural determinants of health disproportionately affect those experiencing incarceration, making them more vulnerable to COVID-19. Additionally, prisons are sites of congregate living, making it impossible to practice social distancing, and most prisons have relied only on incremental measures to reduce risk and spread of COVID-19. To more fully understand the impact that COVID-19 is having on incarcerated populations, it is critical to have systematic data on testing, test positivity, cases, and case fatality. Using data from the COVID Prison Project, we present data on 53 prison systems COVID-19 testing, test positivity, case, and case fatality by state and compare these data with each state’s general population. We do this for the early stages of the pandemic, utilizing data through July 15, 2020. Many states are not reporting full information on COVID testing with some also not reporting on case fatality. Among those reporting data, there is a wide variation between testing, test positivity, and case rates within prison systems and as compared to the general population. However, when more tests are deployed more cases are identified with the majority of state prisons having higher case rates than their general population. These findings underscore the need for the implementation and study of COVID-19 mitigation and surveillance strategies to flatten the COVID-19 curve in prisons across the country. We call for future research to build on these data from the COVID Prison Project to protect the health of our nations’ often forgotten residents.
Working Conditions Supporting Person-Centered Care of Persons Living with Dementia in Long-Term Care Homes
The COVID-19 pandemic has underscored the importance of person-centered dementia care and working conditions that support such care in long-term care (LTC) home settings. Personal support workers (PSWs), known also as certified nursing assistants, provide the most direct formal care for persons living with dementia. However, little is known about the working conditions that enable person-centered care. Accordingly, the purpose of this study was to examine the working conditions and the impact of those conditions on PSWs in LTC homes. PSWs (N=39) employed at one of five LTC homes in southwestern Ontario, Canada participated in a series of one-hour focus groups before, during, and after Be-EPIC, a person-centred communication training program for formal caregivers of persons living with dementia. Using an interpretive description investigative framework, textual data from focus group conversation transcripts were open-coded into categories. Overarching themes were interpreted inductively. Study credibility was enhanced through investigator triangulation. Three themes emerged related to working conditions of PSWs: dementia care is complex, lack of trained staff to provide person-centered dementia care, and residents’ families are not situated in the residents’ care circle. Four themes emerged related to the impact of current working conditions of PSWs: occupational burnout, poor resident care, frustrated and disengaged families, and PSWs leave their role. The findings offer opportunities for employers to ameliorate working conditions to support person-centered care. We conclude with specific workplace recommendations that respond to the complexity of dementia care and the associated occupational stresses PSWs experience in the current LTC environment.
Parental buffering in the context of poverty: positive parenting behaviors differentiate young children’s stress reactivity profiles
Experiencing poverty increases vulnerability for dysregulated hypothalamic–pituitary–adrenal (HPA) axis functioning and compromises long-term health. Positive parenting buffers children from HPA axis reactivity, yet this has primarily been documented among families not experiencing poverty. We tested the theorized power of positive parenting in 124 parent–child dyads recruited from Early Head Start ( M age = 25.21 months) by examining child cortisol trajectories using five samples collected across a standardized stress paradigm. Piecewise latent growth models revealed that positive parenting buffered children’s stress responses when controlling for time of day, last stress task completed, and demographics. Positive parenting also interacted with income such that positive parenting was especially protective for cortisol reactivity in families experiencing greater poverty. Findings suggest that positive parenting behaviors are important for protecting children in families experiencing low income from heightened or prolonged physiologic stress reactivity to an acute stressor.
Cardiovascular Health among U.S. Indigenous Peoples: A Holistic and Sex-Specific Systematic Review
The purpose of this systematic review is to examine mental, sociocultural, behavioral, and physical risk and protective factors related to cardiovascular disease (CVD) and related outcomes among U.S. Indigenous peoples. A total of 51 articles met the inclusion criteria of research focusing factors for CVD among U.S. Indigenous peoples (Mental n = 15; Sociocultural, n = 17; Behavioral/Physical, n = 19). This review reveals clear risks for CVD, which tended to be elevated for females. Mental health problems (depression, anxiety, PTSD/trauma, alcohol, and other drug (AOD) abuse) were clearly associated with CVD, along with enculturation, social support, and the social environment – including discrimination and trauma. Poor diet and obesity, diabetes, hypertension, cholesterol were behavioral or physical factors. Overall, identified research was limited and in beginning stages, lacking more information on etiology of the interconnections across sex and the mental, sociocultural, and behavioral determinants of CVD.
Assessment of Pediatric Optic Neuritis Visual Acuity Outcomes at 6 Months
Importance: Optic neuritis (ON) in children is uncommon. There are limited prospective data for visual acuity (VA) outcomes, associated diseases, and neuroimaging findings. Prospective data from a large sample would be useful for counseling families on treatment decisions and prognosis. Objective: To prospectively study children with a first episode of ON, describe VA after 6 months, and ascertain the network’s (Pediatric Eye Disease Investigator Group and Neuro-Ophthalmology Research Disease Investigator Consortium) ability to enroll pediatric patients with ON prospectively. Design, setting, and participants: This nonrandomized cohort study was conducted from September 20, 2016, to July 20, 2018, at 23 sites in the United States and Canada in pediatric ophthalmology or neuro-ophthalmology clinics. A total of 44 children (aged 3-15 years) presented with a first episode of ON (visual loss, pain on eye movements, or both) within 2 weeks of symptom onset and at least 1 of the following in the affected eye: a distance high-contrast VA (HCVA) deficit of at least 0.2 logMAR below age-based norms, diminished color vision, abnormal visual field, or optic disc swelling. Exclusion criteria included preexisting ocular abnormalities or a previous episode of ON. Main outcomes and measures: Primary outcomes were monocular HCVA and low-contrast VA at 6 months. Secondary outcomes were neuroimaging, associated diagnoses, and antibodies for neuromyelitis optica and myelin oligodendrocyte glycoprotein. Results: A total of 44 children (mean age [SD], 10.2 [3.5] years; 26 boys [59%]; 23 White individuals [52%]; 54 eyes) were enrolled in the study. Sixteen patients (36%) had bilateral ON. Magnetic resonance imaging revealed white matter lesions in 23 children (52%). Of these children, 8 had myelin oligodendrocyte glycoprotein-associated demyelination (18%), 7 had acute disseminated encephalomyelitis (16%), 5 had multiple sclerosis (11%), and 3 had neuromyelitis optica (7%). The baseline mean HCVA was 0.95 logMAR (20/200), which improved by a mean 0.76 logMAR (95% CI, 0.54-0.99; range, -0.70 to 1.80) to 0.12 logMAR (20/25) at 6 months. The baseline mean distance low-contrast VA was 1.49 logMAR (20/640) and improved by a mean 0.72 logMAR (95% CI, 0.54-0.89; range, -0.20 to 1.50) to 0.73 logMAR (20/100) at 6 months. Baseline HCVA was worse in younger participants (aged <10 years) with associated neurologic autoimmune diagnoses, white matter lesions, and in those of non-White race and non-Hispanic ethnicity. The data did not suggest a statistically significant association between baseline factors and improvement in HCVA. Conclusions and relevance: The study network did not reach its targeted enrollment of 100 pediatric patients with ON over 2 years. This indicates that future treatment trials may need to use different inclusion criteria or plan a longer enrollment period to account for the rarity of the disease. Despite poor VA at presentation, most children had marked improvement by 6 months. Associated neurologic autoimmune diagnoses were common. These findings can be used to counsel families about the disease.
Opportunity beckons: a case for community practice within the classroom
Current trends point toward the marginalization of community practice in the field of social work and social work education. Since community practice education is heavily informed by trends in the field, the opportunity for educational expansion is immediate and great. This moment necessitates a move toward methods of community practice education that emphasize practitioner skill development in theory, creativity, collaboration, understanding, and investment. In an attempt to address the need for community-practice education, the authors present a challenging and innovative assignment for graduate students that encouraged university/community partnerships through experiential community experiences.
Social work and the state: Perspectives and practice
The state has been central to social work throughout the profession’s history. Despite its theoretical and political significance, the mainstream of the social work field has long disregarded the state as an object of inquiry. The scant attention given to the state within social work is especially puzzling given a resurgence of interest in the state within the social sciences over the past few decades. To redress this imbalance, this article explores six influential theories of the state and discusses their implications for social work practice and policy. These theories suggest we conceive of the state as: a liberal and caring guardian; a tool for class dominance; a means of social control; a political practice; an institutional structure; and a cultural construct. Drawing on diverse literatures, the article advances the understanding of social work that takes seriously the problem of the state.
Disrupting hegemony in social work doctoral education and research: Using autoethnography to uncover possibilities for radical transformation
Social work has enhanced its profile in the United States by adopting a particular dialect of scientific inquiry wherein positivism and evidence-based practice are considered gold standards of social work research and practice. This ideological shift permeates doctoral education and research training, as well as social work more broadly. Little attention, however, is paid to the pedagogical approaches used to train doctoral students into a “science of social work,” and we know even less about critical methodologies in doctoral education. This collaborative autoethnography weaves together the personal narratives of three doctoral students and one early career faculty member navigating an academic context within a large public university in the United States. We employ a participatory and intersectional approach to analyze narrative data in terms of how our identities interact with the structures relevant to where we study and work. Three themes emerged from our collaborative analysis: becoming disillusioned by disciplinary shortcoming; confronting dissonance with radical solidarity; and making change on the inside using perspectives from the outside. We argue throughout that critical reflexivity is a tool to document, resist, and transform hegemonic discourse that narrowly defines what it means to embody social work research, practice, and education.
Consideration of Heterogeneity in a Meta-analysis of Latino Sexual Health Interventions
Latino adolescents are disproportionately affected by teenage pregnancy, sexually transmitted infections, and HIV, persistent sexual and reproductive health (SRH) disparities that represent a national public health concern. Despite progress nationally, Latina adolescents continue to exhibit above-average teenage pregnancy, birth, and repeat birth rates.1 Particularly concerning are the 17% increase in reportable sexually transmitted infections among 10- to 19-year-old Latino adolescents since 2014 and the 6% rise in new HIV diagnoses among 13- to 19-year-old Latino adolescents between 2016 and 2017 alone.2–4 Given these statistics, research is needed to strengthen the evidence on programs to reduce Latino adolescent SRH disparities.
A confirmatory factor analysis of the beck anxiety inventory in Latinx primary care patients
Research on the Beck Anxiety Inventory (BAI) with ethnic minorities in the U.S. is limited. Because Latinxs constitute 18% of the U.S. population and are the second largest ethnic group in the country, the current study replicated the aforementioned study and examined the BAI factor structure with a Spanish-speaking Latinx sample in the United States. We investigated the original two-factor structure of the BAI with 149 Spanish-speaking Latinx primary care patients. Results from a confirmatory factor analysis indicated that the previous factor structures of the BAI did not represent an adequate fit for our sample. An exploratory factor analysis indicated that possibly an alternate two-factor model of anxiety was the best fit for the data. Cultural considerations are discussed including the possibility of utilizing cultural idioms of distress as a way to assess anxiety among Latinxs.
Measurement of Economic Abuse Among Women Not Seeking Social or Support Services and Dwelling in the Community
Scholars have defined economic abuse (EA) as tactics used by abusive partners to undermine the self-sufficiency and economic self-efficacy of survivors of intimate partner violence (IPV). However, no measures of EA have been tested in non-IPV-service seeking samples. The current study assesses the psychometric properties of the Scale of Economic Abuse (SEA)-12 (Postmus, Plummer, & Stylianou, 2016) in a nonservice seeking sample of adult females attending community college. A quantitative web-based survey was administered to a simple random sample of female community college students (n = 435). Analyses included confirmatory factor analysis (CFA) and exploratory factor analysis (EFA). CFA indicated a poor fit for the three-factor model of the SEA-12 in this sample. The results of the EFA found a single factor model retaining four items (the Scale of Economic Abuse-Short, or SEAS). Women are experiencing EA outside of IPV service-seeking populations, and that tactics of economic control seem to be central to EA in this sample.
Beyond the Classroom: The Intergenerational Effect of Incarceration on Children’s Academic and Nonacademic School-Related Outcomes in High School
The author uses strategic comparison regression and the Longitudinal Study of Adolescent to Adult Health (n = 11,767) to explore the effect of parental incarceration on academic and nonacademic outcomes in high school. This method compares youth whose parents were incarcerated before the outcomes are measured with those whose parents will be incarcerated after. The author examines most recent grades and a range of nonacademic outcomes, such as truancy, involvement in school activities, and suspension. Results indicate that the associations between parental incarceration and grades are largely accounted for by selection, but associations between parental incarceration and nonacademic processes persist. Maternal incarceration holds particular importance for behavioral outcomes (fighting and truancy), and paternal incarceration holds particular importance for behavioral, connectedness, and disciplinary outcomes. Researchers examining the intergenerational consequences of incarceration should examine school contexts beyond the classroom and explore the pathways through which this disadvantage occurs.
A Qualitative Study of Intimate Partner Violence and Employment Instability
Maintaining employment while suffering from intimate partner violence (IPV) is extremely difficult given the direct and indirect ways abusers disrupt work. The current qualitative study seeks to strategically fill a gap in knowledge regarding survivors’ employment instability and gain insight toward creating more supportive workplaces for survivors. Women (N = 19) receiving services for IPV at a Midwest U.S. agency were interviewed about their experiences of employment instability, workplace disruptions (including via technology), and their perceptions of policies and practices that employers use to support employees experiencing abuse. Specifically, the study asks four research questions to address gaps in literature: (a) What are the employment instability experiences of survivors related to IPV, including attendance, hours, and job loss? (b) What are survivors’ experiences of workplace disruptions, including with technology? (c) What formal employer policies and practices related to IPV are survivors familiar with? and (d) What workplace supports do IPV survivors perceive to be helpful or harmful? Findings uniquely contribute to existing literature by revealing employment instability among mothers, highlighting the use of technology to disrupt survivors’ work, and determining existing policies and procedures that workplaces use to address IPV. Implications for advocates working with survivors as well as employer and state policymakers are discussed.
Test-Taking for Gifted and Talented Kindergarten: Underscoring the Importance of Outreach
Using proprietary data collected prior to the establishment of the public Universal Prekindergarten program in New York City, this study finds statistically significant differences in test-taking rates for the city’s Gifted & Talented (G & T) program between two matched samples of students—those who attended a public prekindergarten (pre-K) program and those who did not—for each of four cohorts from 2008 to 2011, favoring the public pre-K group. Results also demonstrate that access to information about the G & T program is a plausible mechanism underlying the higher test-taking rates among the public pre-K group, especially for underrepresented groups. With the establishment of the Universal Prekindergarten in New York City in 2015, our results highlight the importance of instituting new policies for promoting the dissemination of information regarding the G & T admissions process within the public school sector. If targeted to address diversity in G & T, such policies could help reduce inequality in gifted education.
Organizing as “Collective-Self” Care Among African American Youth in Precarious Times
African American youth have responded with hope and action to protect their well-being in violent political, economic, and social conditions, through organizing. While contemporary organizing frameworks prioritize self-care to promote sustainability, there is little research on the meaning and definition of self-care for African American youth organizers, in their own words. In this paper, findings from interviews with 20 Black youths in navigating organizing spaces in New York City will be presented, highlighting how they destabilize the narrowness of commonly defined self-care to embody “collective-self” care strategies. Implications for community practice, recovery from systemic violence, and historical trauma among African Americans will be explored.
#PrEP4Love: success and stigma following release of the first sex-positive PrEP public health campaign
Pre-exposure prophylaxis (PrEP) is an effective yet under-utilised method for preventing HIV transmission in high-risk groups. Despite ongoing social marketing to increase PrEP awareness, few studies have evaluated public responses. This paper contextualises negative responses to Chicago’s PrEP4Love campaign. In February 2016, a sex-positive ad campaign called PrEP4Love was launched online and throughout public spaces in Chicago. A gender and sexuality inclusive campaign, PrEP4Love is intended to be culturally responsive and sex positive, while retaining a focus on risk reduction. Advertisements prominently feature Black sexual minority men, and Black transgender women, and were strategically placed in diverse Chicago neighbourhoods. In response, there were 212 new callers to the PrEPLine during the two-month study period. Negative responses were concerned with: negatively depicting Black homosexuality (4), general anti-LGBTQ comments (7), adverse effects on children (6), sexually explicit nature (5), and general stigmatisation of racial minorities (4). Discussion focuses on sex-positive frameworks, normalising intimacy, stigma and historical mistrust of medical and pharmaceutical institutions, and the social meanings of biomedical prevention technologies (e.g. PrEP) in relation to dominant norms of sexuality and gender. This study is the first to investigate public responses to a sex-positive PrEP campaign. More studies of PrEP social marketing are needed to evaluate targeted public health campaigns to guide future PrEP promotion strategies.