Promotive Factors and Psychosocial Adjustment Among Urban Youth

Background

Urban youth are often exposed to compounded risk factors which make them more vulnerable to negative outcomes. Research examining promotive factors which may reduce vulnerabilities to poor psychosocial adjustment among this population is limited.

Objective

The current study addresses this limitation by examining the impact of self-efficacy and positive expectations about the future, as promotive factors, on levels of depressive and anxious symptomatology, sense of belonging, and friendship among a sample of urban youth.

Methods

Data are from 1202 4th and 5th grade students enrolled at 27 elementary schools in a high poverty, high minority school district in the Southeastern United States.

Results

Using ordinary least squares regression, analyses reveal that promotive factors are significant predictors of psychosocial adjustment and thus have implications for improving negative outcomes among urban minority youth.

Conclusions

The findings suggests that interventions aimed at increasing self-efficacy and positive expectations about the future may reduce child and adolescent vulnerability to negative outcomes associated with poor psychosocial adjustment.

     

Community Health Workers and Community Advocacy: Addressing Health Disparities

The Community Health Worker model is recognized nationally as a means to address glaring inequities in the burden of adverse health conditions that exist among specific population groups in the United States. This study explored Arizona CHW involvement in advocacy beyond the individual patient level into the realm of advocating for community level change as a mechanism to reduce the structural underpinnings of health disparities. A survey of CHWs in Arizona found that CHWs advocate at local, state and federal political levels as well as within health and social service agencies and business. Characteristics significantly associated with advocacy include employment in a not for profit organization, previous leadership training, and a work environment that allows flexible work hours and the autonomy to start new projects at work. Intrinsic characteristics of CHWs associated with advocacy include their belief that they can influence community decisions, self perception that they are leaders in the community, and knowledge of who to talk to in their community to make change. Community-level advocacy has been identified as a core CHW function and has the potential to address structural issues such as poverty, employment, housing, and discrimination. Agencies utilizing the CHW model could encourage community advocacy by providing a flexible working environment, ongoing leadership training, and opportunities to collaborate with both veteran CHWs and local community leaders. Further research is needed to understand the nature and impact of CHW community advocacy activities on both systems change and health outcomes.     

Behavioral Adaptation Among Youth Exposed to Community Violence: a Longitudinal Multidisciplinary Study of Family, Peer and Neighborhood-Level Protective Factors

Several studies across fields have documented the detrimental effects of exposure to violence and, separately, the power of developmental assets to promote positive youth development. However, few have examined the lives of youth exposed to violence who demonstrate resilience (that is, positive adjustment despite risk), and hardly any have examined how developmental assets may shape resilient trajectories into adulthood for youth exposed to violence. What are these resources and relationships that high-risk youth can leverage to tip the balance from vulnerability in favor of resilience? We used generalized estimating equations to examine multilevel longitudinal data from 1,114 youth of ages 11–16 from the Project on Human Development in Chicago Neighborhoods. Behavioral adaptation was a dynamic process that varied over time and by level of violence exposure. In the short term, being a victim was associated with increased aggression and delinquency. In the long term though, both victims and witnesses to violence had higher odds of behavioral adaptation. Baseline family support and family boundaries, friend support, neighborhood support, and collective efficacy had positive main effects for all youth. Additionally, having family support, positive peers, and meaningful opportunities for participation modified the effect of exposure to violence and increased odds of behavioral adaptation over time. Policies, systems, and programs across sectors should focus on building caring relationships/supports with family members and friends, positive peers, and meaningful opportunities especially for witnesses and victims of violence, to promote behavioral resilience and related outcomes into adulthood for high-risk youth.     

Health Literacy and Associated Factors Among Hmong American Immigrants: Addressing the Health Disparities

Hmong Americans face a disproportionate health burden ranging from the high prevalence of diabetes to depressive disorders. Little research attention has been paid toward exploring contributing factors to this disparity. As such, the present study seeks to fill the gap in the literature by examining the health literacy levels in Hmong Americans and its associated factors. The present study employed Andersen’s behavioral model of health service as the theoretical framework. A cross-sectional survey research design was used and information was gathered from 168 Hmong American immigrants. Participants were recruited using a purposive sampling strategy. A multiple regression analysis was conducted to identify the factors linked to health literacy. Approximately half of the participants had low health literacy and reported that they did not understand health information well. Health literacy levels were found to differ significantly based on the number of years participants have lived in the U.S., their social or religious group attendance, health status, and whether they had difficulties with activities of daily living. Our exploratory findings could be used prompt more research to help inform the development of interventions aiming to improve health literacy levels and address the health disparities in Hmong American Population.     

Heterogeneity of Falls Among Older Adults: Implications for Public Health Prevention

Objectives. We examined risk factors for falls among older people according to indoor and outdoor activity at the time of the fall and explored risk factors for seriously injurious falls.Methods. Data came from MOBILIZE Boston, a prospective cohort study of 765 community-dwelling women and men, mainly aged 70 years or older. Over 4.3 years, 1737 falls were recorded, along with indoor or outdoor activity at the time of the fall.Results. Participants with poor baseline health characteristics had elevated rates of indoor falls while transitioning, walking, or not moving. Healthy, active people had elevated rates of outdoor falls during walking and vigorous activity. For instance, participants with fast, rather than normal, gait speed, had a rate ratio of 7.36 (95% confidence interval [CI] = 2.54, 21.28) for outdoor falls during vigorous activity. The likelihood of a seriously injurious fall also varied by personal characteristics, activity, and location. For example, the odds ratio for serious injury from an outdoor fall while walking outside compared to inside a participant’s neighborhood was 3.31 (95% CI = 1.33, 8.23).Conclusions. Fall prevention programs should be tailored to personal characteristics, activities, and locations.Falls in older people are a major public health problem. In the United States, about one third of community-dwelling people aged 65 years or older fall each year, with about 10% of falls resulting in serious injury.1–3 These falls and injuries can lead to disability, loss of independence, and fear of falling.1 Several fall prevention strategies have been developed, most of which emphasize strength, balance, and gait training; use of assistive devices; treatment of medical conditions; reduction in the use of certain medications; improvement in vision; and elimination of home hazards.1–6 However, about 50% of falls in community-dwelling older people occur outdoors, mainly in healthy, active people.7–13 Knowing which people are likely to fall under what circumstances should help prevention efforts by enabling different recommendations to be emphasized to different people, a strategy recommended in the 1990s by Northridge et al.14,15 and Speechley and Tinetti,16 but seldom implemented as policy.Previous studies have reported on people’s activities at the time they fall, with walking by far most frequent.9,17–19 However, only limited data are available on whether certain personal characteristics affect the likelihood of falls during specific activities, and on which combinations of fall-related activities, personal characteristics, and location are most likely to result in serious injury among those who fall.14,17Our objectives were (1) to examine whether particular personal characteristics (e.g., demographic, lifestyle, and health attributes; functional and cognitive status; fall history) are associated with falls during certain indoor and outdoor activities and (2) to explore, with smaller numbers of events, risk factors for serious injury from falls according to personal characteristics, activity, and location. Such information can contribute to the development of more effective public health prevention strategies tailored to specific groups of people and activities.     

The Relationship Between Peer, Social, and School Factors, and Delinquency Among Youth

ABSTRACT: This article examines the relationships between self-reported delinquency and peer, social, and school factors among junior and senior high school students in Calgary, Alberta, Canada, using both cross-tabulation and multiple-regression analyses. A greater number of ninth grade students were delinquent compared to students in the other grades studied. Predictably, peers' level of delinquency correlated strongly and positively with students' level of delinquency. Strong, positive correlations with delinquency also were found for students reporting high levels of involvement in sports, and high levels of involvement in commercial/entertainment activities. Multivariate analyses indicated the strongest predictor of delinquent behavior within the group of peer and social variables was peer delinquency. Within the group of school variables, the strongest predictors of delinquent behavior were how often classes were skipped and the number of times students were suspended from school. However, students' grades in school did not significantly increase the accuracy of the regression eqution.     

Community Health Partnerships for Chronic Disease Prevention Among Latinos: The San Diego Prevention Research Center

Over 20 years ago, university–community partnerships (i.e., Prevention Research Centers [PRCs]) across the United States were funded by the Centers for Disease Control and Prevention to conduct research and training in order to promote health and prevent disease in underserved populations. In 2004, the San Diego PRC (SDPRC) became the first PRC to focus on obesity prevention and control in a community of mostly Mexican Americans/Mexican immigrants. The SDPRC was also the first PRC to comprise a university–community partnership with a school of public health, a school of medicine, and a federally qualified health center. In conjunction with two additional funded community partners and involvement of a community advisory board, the SDPRC seeks to develop effective intervention strategies that ultimately lead to behavior change. Now in its second cycle of funding, the SDPRC has identified three primary principles that are important for these and similar efforts: (1) developing culturally appropriate interventions requires community engagement; (2) building the evidence in a systematic and rigorous way yields meaningful strategies for translation to practice; and (3) translating evidence-based interventions to practice involves capacity building for both researchers and community partners. This article describes these principles to help others involved in similar intervention efforts identify the best approach for promoting health in their own communities.     

Ethnic Differences for Public Health Knowledge,Health Advocacy Skills,and Health Information Seeking Among High School Students: Community Agents of Change

Although adult health advocacy programs have been examined in communities, little is known about integrated adolescent health advocacy programs in high schools. The purpose of this study was to examine the health advocacy program impact and ethnic differences among high school students. Using a cross-sectional study, high school students participating in the school-based program completed evaluation surveys. The program domains included upstream causes of health, community assets, and public health advocacy. Bivariate analyses were conducted to examine ethnic differences for public health knowledge, health advocacy skills, and health information seeking behaviors. Using thematic analysis, open-ended survey item responses were coded to identify themes for students’ perceptions of community health. Non-Hispanic (n?=?72) and Hispanic high school students (n?=?182) in ten classes reported owning smartphones (95%) and laptops (76%). Most students (72%) reported seeking online health information. Non-Hispanic students reported significantly higher health advocacy skills for speaking with the class about health issues, identifying community services, or creating health awareness at school than Hispanic students. Non-Hispanic students were more likely to seek health information from fathers and television than Hispanic students. Hispanic students were more likely to seek health information from hospital or clinic staff than non-Hispanic students. Emergent themes included health advocacy skills, community awareness, and individual and community health changes. High schools benefit from integrating health advocacy programs into the core curriculum. Adolescents gain important skills to improve their individual health and engage in changing community health.     

Acceptance and Commitment: Implications for Prevention Science

Recent research in behavior analysis and clinical psychology points to the importance of language processes having to do with the control of negative cognition and emotion and the commitment to valued action. Efforts to control unwanted thoughts and feelings, also referred to as experiential avoidance (EA), appear to be associated with a diverse array of psychological and behavioral difficulties. Recent research shows that interventions that reduce EA and help people to identify and commit to the pursuit of valued directions are beneficial for ameliorating diverse problems in living. These developments have the potential to improve the efficacy of many preventive interventions. This paper reviews the basic findings in these areas and points to some ways in which these developments could enhance the impact of preventive interventions.     

Assessing Community Health Among Indigenous Populations in Ecuador with a Participatory Approach: Implications for Health Reform

Health reform is an important movement in countries throughout the region of the Americas, which could profoundly influence how basic health services are provided and who receives them. Goals of health sector reform include to improve quality, correct inefficiencies, and reduce inequities in current systems. The latter may be especially important in countries with indigenous populations, which are thought to suffer from excess mortality and morbidity related to poverty. The purpose of this paper is to report the results of a community health assessment conducted in 26 indigenous communities in the Province of Cotopaxi in rural Ecuador. It is hoped that this information will inform the health reform movement by adding to the current understanding of the health and socioeconomic situation of indigenous populations in the region while emphasizing a participatory approach toward understanding the social forces impacting upon health. This approach may serve as a model for empowering people through collective action. Recommended health reform strategies include: 1) Develop a comprehensive plan for health improvement in conjunction with stakeholders in the general population, including representatives of minority groups; 2) Conduct research on the appropriate mix between traditional medicine, primary health care strategies, and high technology medical services in relation to the needs of the general population; 3) Train local health personnel and traditional healers in primary health care techniques; 4) Improve access to secondary and tertiary health services for indigenous populations in times of emergency; and 5) Advocate for intersectoral collaboration among government institutions as well as non-governmental organizations and the private sector.     

Patterns of Family Health History Communication Among Older African American Adults

This qualitative study examined patterns of communication regarding family health history among older African American adults. The authors conducted 5 focus groups and 6 semi-structured interviews with African Americans aged 60 years and older (N = 28). The authors identified 4 distinct patterns of family health history communication: noncommunication, open communication, selective communication (communication restricted to certain people or topics), and one-way communication (communication not reciprocated by younger family members). In general, participants favored open family health history communication, often resulting from desires to change patterns of noncommunication in previous generations regarding personal and family health history. Some participants indicated that they were selective about what and with whom they shared health information in order to protect their privacy and not worry others. Others described family health history communication as one-way or unreciprocated by younger family members who appeared uninterested or unwilling to share personal and family health information. The communication patterns that the authors identified are consistent with communication privacy management theory and with findings from studies focused on genetic testing results for hereditary conditions, suggesting that individuals are consistent in their communication of health and genetic risk information. Findings may guide the development of health message strategies for African Americans to increase family health history communication.     

Prevalence and Community Variation in Harmful Levels of Family Conflict Witnessed by Children: Implications for Prevention

Children’s reports of high family conflict consistently predict poor outcomes. The study identified criteria for high family conflict based on prospective prediction of increased risk for childhood depression. These criteria were subsequently used to establish the prevalence of high family conflict in Australian communities and to identify community correlates suitable for targeting prevention programs. Study 1 utilised a longitudinal design. Grade 6 and 8 students completed a family conflict scale (from the widely used Communities That Care survey) in 2003 and depression symptomotology were evaluated at a 1-year follow-up (International Youth Development Study, N?=?1,798). Receiver-operating characteristic analysis yielded a cut-off point on a family conflict score with depression symptomatology as a criterion variable. A cut-off score of 2.5 or more (on a scale of 1 to 4) correctly identified 69 % with depression symptomology, with a specificity of 77.2 % and sensitivity at 44.3 %. Study 2 used data from an Australian national survey of Grade 6 and 8 children (Healthy Neighbourhoods Study, N?=?8,256). Prevalence estimates were calculated, and multivariate logistic regression with multi-level modelling was used to establish factors associated with community variation in family conflict levels. Thirty-three percent of Australian children in 2006 were exposed to levels of family conflict that are likely to increase their future risk for depression. Significant community correlates for elevated family conflict included Indigenous Australian identification, socioeconomic disadvantage, urban and state location, maternal absence and paternal unemployment. The analysis provides indicators for targeting family-level mental health promotion programs.     

Adverse Childhood Experiences and Suicidal Behaviors Among Youth: The Buffering Influence of Family Communication and School Connectedness

PurposeThe main objectives of this study were to determine (1) whether family communication and school connectedness offer protection against suicidal behaviors in the presence of adverse childhood experiences (ACEs; direct protective effect) and (2) whether family communication or school connectedness buffer the association between ACEs and suicidal behaviors (interacting protective effect) on the multiplicative and additive scales.MethodsData were obtained from a western state's 2019 Youth Risk Behavior Survey that included 5,341 middle school and 4,980 high school participants. Generalized linear models were used to estimate whether family communication and school connectedness offered direct protection against suicidal behaviors or buffered the association between ACEs and suicidal behaviors using adjusted prevalence ratios and corresponding 95% confidence intervals.ResultsFamily communication and school connectedness offered direct protection against suicidal behaviors in the presence of ACEs (a 1-unit higher score was associated with a 32%–42% lower prevalence of suicidal behaviors for middle school youth and a 27%–39% lower prevalence of suicidal behaviors for high school youth). There was evidence that family communication and school connectedness buffered the association between ACEs and suicidal behaviors on the multiplicative scale.ConclusionsThe findings provide support for the development and implementation of interventions that build family communication and school connectedness to reduce suicidal behaviors. Furthermore, screening for trauma and suicidal behaviors is warranted.     

Drinking Patterns Among Korean Adults: Results of the 2009 Korean Community Health Survey

Objectives

In Korea, the proportion of deaths due to alcohol is estimated at 8.9%, far exceeding the global estimate of 3.8%. Therefore, this study was performed to examine the factors associated with low-risk, moderate-risk, and high-risk drinking patterns in Korean adults and to identify target populations for prevention and control of alcohol-related diseases and deaths.

Methods

We analyzed data from 230 715 Korean adults aged 19 years and older who participated in the 2009 Korean Community Health Survey. Multinomial logistic regression analysis was used to examine associations between socio-demographic and health-related factors and patterns of alcohol use.

Results

A substantially larger proportion of men than women engaged in high risk (21.2% vs. 3.4%) and moderate-risk alcohol use (15.5% vs. 8.2%). In both sexes, moderate- and high-risk uses were associated with younger age, higher income, being currently employed, smoking, being overweight/obese, and good self-rated health.

Conclusions

Given the large proportion of the population that is engaging in moderate- and high-risk drinking and given the social norms that support this behavior, public health policies and campaigns to reduce alcohol consumption targeting the entire population are indicated.