Disparities in Use of Mental Health and Substance Abuse Services by Asian and Native Hawaiian/Other Pacific Islander Women

The purpose of this study was to determine if disparities exist in lifetime utilization of mental health/substance abuse services among Asian, Native Hawaiian/Other Pacific Islander (NHOPI) and white mothers. The study sample was comprised of mothers assessed to be at-risk (n = 491) and not at-risk (n = 218) for child maltreatment in the Hawaii Healthy Start Program study. Multiple logistic regression models were used to test the effects of predisposing, need, and enabling factors on utilization of services. Results revealed that, among mothers with depressive symptoms, compared with whites, Asians and NHOPI were significantly less likely to have received services. There were no significant racial differences in use of mental health/substance use services by other factors. These results suggest that racial disparities exist in utilization of mental health/substance abuse services among mothers with depressive symptoms. Future research is needed to identify barriers and facilitators to accessing needed services for Asian and NHOPI women.     

Preventing Early Child Maltreatment: Implications from a Longitudinal Study of Maternal Abuse History,Substance Use Problems,and Offspring Victimization

In the interest of improving child maltreatment prevention science, this longitudinal, community based study of 499 mothers and their infants tested the hypothesis that mothers’ childhood history of maltreatment would predict maternal substance use problems, which in turn would predict offspring victimization. Mothers (35% White/non-Latina, 34% Black/non-Latina, 23% Latina, 7% other) were recruited and interviewed during pregnancy, and child protective services records were reviewed for the presence of the participants’ target infants between birth and age 26 months. Mediating pathways were examined through structural equation modeling and tested using the products of the coefficients approach. The mediated pathway from maternal history of sexual abuse to substance use problems to offspring victimization was significant (standardized mediated path [ab] = .07, 95% CI [.02, .14]; effect size = .26), as was the mediated pathway from maternal history of physical abuse to substance use problems to offspring victimization (standardized mediated path [ab] = .05, 95% CI [.01, .11]; effect size = .19). There was no significant mediated pathway from maternal history of neglect. Findings are discussed in terms of specific implications for child maltreatment prevention, including the importance of assessment and early intervention for maternal history of maltreatment and substance use problems, targeting women with maltreatment histories for substance use services, and integrating child welfare and parenting programs with substance use treatment.     

Mental Health Screening of Adolescents in Pediatric Practice

This study examines routine computerized mental health screening for adolescents scheduled for a routine physical examination in a group pediatric practice. Medical records of adolescents aged 13 to 17 who were offered screening (n = 483) were reviewed. Approximately 44.7% (95% confidence interval (CI) 40.3–49.2) were screened, and 13.9% (95% CI 9.3–18.5) were identified as being at risk. Screening was associated with significantly increased odds of receiving either pediatric mental health care or a referral for specialty mental health care (adjusted odds ratio (AOR): 2.6 95% CI 1.2–5.6). Among patients who received either mental health intervention, those who were screened were significantly more likely to be referred to specialty care (AOR: 15.9 95% CI 2.5–100.4), though they were less likely to receive pediatric mental health care (AOR: 0.10 95% CI 0.02–0.54). The findings support the feasibility of routine mental health screening in pediatric practice. Screening is acceptable to many parents and adolescents, and it is associated with referral for specialized mental health care rather than care from the pediatrician.     

Housing as an Intervention on Hospital Use: Access among Chronically Homeless Persons with Disabilities

A study examining demographics and hospital utilization for chronically homeless persons with disabilities was conducted at pre-housing enrollment and at 6 months post-housing. Of the 20 participants, 70% (n = 14) were Black American and 30% (n = 6) were White; 100% (n = 20) were non-Hispanic; 90% (n = 18) were men; 40% (n = 8) were veterans; Median years since last permanent housing and total homelessness were 7 and 10.5 respectively. The following increases were observed: employment (0 to 1); income (20%, n = 4 to 35%, n = 7); primary care (25%, n = 5 to 95%, n = 19); and mental health service use (25%, n = 5 to 60%, n = 12). Known disabilities included HIV (15%, n = 3); hepatitis C (45%, n = 9); mental illness (60%, n = 12) and substance abuse (80%, n = 16) with 45% (n = 9) dually diagnosed. Over the course of the study, Emergency department visits and inpatient hospitalization use decreased. While these differences were not statistically significant (p = 0.14 and p = 0.31, respectively), they translate to an estimated $250,208 savings.     

Effects of the Family Check-Up 4 Health on Parenting and Child Behavioral Health: A Randomized Clinical Trial in Primary Care

The Family Check-Up 4 Health (FCU4Health) is an adaptation of the Family Check-Up (FCU) for delivery in primary care settings. While maintaining the original FCU’s focus on parenting and child behavioral health, we added content targeting health behaviors. This study evaluated whether the adapted FCU maintained positive effects on parenting (positive behavior support, limit setting, parental warmth) and child behavioral health (self-regulation, conduct problems, emotional problems). Pediatric (6–12 years) primary care patients with a BMI?≥?85^th%ile (n?=?240) were recruited from primary care clinics in Phoenix. Children were 75% Latino, 49% female, and 73% Medicaid recipients. This type 2 effectiveness-implementation hybrid trial compared families randomized to FCU4Health (n?=?141) or usual care (n?=?99). FCU4Health was delivered over a period of 6 months. This study focuses on a priori secondary outcomes included parenting and child behavioral health targets of the original FCU, assessed at baseline and 3, 6, and 12 months. Significant improvements were found for the FCU4Health condition, compared to usual care, in parenting from baseline to the 3-month assessment [β?=?.17 (.01; .32)]. Parenting predicted improvements in child self-regulation at 6-months [β?=?.17 (.03; .30)], which in turn predicted reductions in conduct problems [β?=?? .38 (? .51; ? .23)] and emotional problems [β?=?? .24 (? .38; ? .09)] at 12 months. Ethnicity and language of delivery (English or Spanish) did not moderate these effects. The FCU4Health can improve parenting and child behavioral health outcomes when delivered in primary care.

Trial Registration Trial registration number: NCT03013309 ClinicalTrials.gov

     

A Three-Generational Study of Risk Factors for Childhood Externalizing Behavior among African Americans and Puerto Ricans

This is the first prospective study to examine the precursors of child externalizing behavior across three generations of African Americans and Puerto Ricans. Participants comprised a community cohort of male and female African Americans and Puerto Ricans (N = 366, [`(X)] \overline{X} age = 29.4 years), who are part of an ongoing study of drug use and problem behaviors, and who had a child. Data were collected at four time waves, spanning the participants’ adolescence to adulthood. Questionnaires were initially self-administered in schools in East Harlem, NY, USA (time 1). Subsequently, structured interviews were conducted by trained interviewers (times 2 and 3), and self-administered via mail (time 4). The independent variables consisted of the participants’ prospective reports of their (a) relationships with their parents during adolescence, (b) depressive mood and drug use (adolescence to adulthood), (c) relationship with their oldest child between the ages of 6–13, and (d) perceptions of neighborhood crime and deterioration (in adulthood). The dependent variable was externalizing behavior in the participant’s oldest child ([`(X)] \overline{X} age = 9.6 years; SD = 2.0). Structural equation modeling showed that the parent–child relationship during participants’ adolescence was linked with the participants’ depressive mood and drug use which, in turn, were associated with the participants’ relationship with their own child, as well as with neighborhood crime and deterioration when participants were adults. The participants’ depressive mood, and relationship with their own child, as well as neighborhood crime and deterioration, each had a direct pathway to externalizing behavior in the participant’s child. Findings suggest that intervention programs and public policy should address parental attributes, neighborhood factors, and, especially, parenting skills, to reduce risk factors for the intergenerational transmission of externalizing behavior.     

Risk for Maternal Harsh Parenting in High-Risk Families From Birth to Age Three: Does Ethnicity Matter?

Child maltreatment prevention programs typically identify at-risk families by screening for risk with limited consideration of how risk might vary by ethnicity. In this study, longitudinal data from mothers who participated in a randomized clinical trial of a home-visitation, child maltreatment prevention program (N = 262) were examined to determine whether risk for harsh parenting differed among mothers who identified themselves as Spanish-speaking Latinas (n = 64), English-speaking Latinas (n = 102), or non-Latina Caucasians (n = 96). The majority of the participants were first-time mothers (58.4%), and the average age of all participants was 23.55 years (SD = 6.04). At the time of their infants’ births, the Spanish-speaking Latina mothers demonstrated higher SES risk, whereas the English-speaking Latina and non-Latina Caucasian mothers demonstrated higher psychosocial risk. Three years later, the English-speaking Latina and non-Latina Caucasian mothers reported harsher parenting behaviors than the Spanish-speaking Latina mothers. The need for prevention programs to consider how risk and protective factors differ by ethnic group membership when identifying at-risk mothers is discussed.     

Pediatric Emergency Consultations: Prior Mental Health Service Use in Suicide Attempters

This study investigated the relationship between presenting complaints and prior mental health encounters in youth seen for emergency psychiatric consultation. Records of youths aged 9–17 years old receiving a psychiatric consultation in a pediatric emergency department from 2002 to 2007 were examined (N = 1,900). Youth were classified by presenting complaint: suicide attempt, suicidal ideation, and behavioral problems. Nearly half of the youth presented with behavior problems, and 39% presented with suicidal ideation and/or attempt. Those presenting with both suicide attempt and behavior problems were most likely to have made a prior suicide attempt. Those presenting with suicide attempt alone were least likely to report current mental health treatment, while youth presenting with behavior problems alone were the most likely to report current mental health treatment. Further research is needed to better understand the role that emergency departments play in the course of care and to maximize the opportunity to make lasting and effective community-based care connections.     

The Strong African American Families–Teen Trial: Rationale, Design, Engagement Processes, and Family-Specific Effects

This study addresses two limitations in the literature on family-centered intervention programs for adolescents: ruling out nonspecific factors that may explain program effects and engaging parents into prevention programs. The Rural African American Families Health project is a randomized, attention-controlled trial evaluating the efficacy of the Strong African American Families–Teen (SAAF–T) program, a family-centered risk-reduction intervention for rural African American adolescents. Rural African American families (n = 502) with a 10th-grade student were assigned randomly to receive SAAF–T or a similarly structured, family-centered program that focused on health and nutrition. Families participated in audio computer-assisted self-interviews at baseline and 6-month follow-up. Program implementation procedures yielded a design with equivalent doses, five sessions of family-centered intervention programming for families in each condition. Of eligible families screened for participation, 76% attended four or five sessions of the program. Consistent with our primary hypotheses, SAAF–T youth, compared to attention-control youth, demonstrated higher levels of protective family management skills, a finding that cannot be attributed to nonspecific factors such as aggregating families in a structured, interactive setting.     

Intimate Partner Abuse among Gay and Bisexual Men: Risk Correlates and Health Outcomes

Little is known about the patterns and types of intimate partner abuse in same-sex male couples, and few studies have examined the psychosocial characteristics and health problems of gay and bisexual men who experience such abuse. Using a cross-sectional survey sample of 817 men who have sex with men (MSM) in the Chicago area, this study tested the effect of psychological and demographic factors generally associated with intimate partner abuse and examined their relationship to various health problems. Overall, 32.4% (n = 265) of participants reported any form of relationship abuse in a past or current relationship; 20.6% (n = 168) reported a history of verbal abuse (“threatened physically or sexually, publicly humiliated, or controlled”), 19.2% (n = 157) reported physical violence (“hit, kicked, shoved, burned, cut, or otherwise physically hurt”), and 18.5% (n = 151) reported unwanted sexual activity. Fifty-four percent (n = 144) of men reporting any history of abuse reported more than one form. Age and ethnic group were unrelated to reports of abuse. Depression and substance abuse were among the strongest correlates of intimate partner abuse. Men reporting recent unprotected anal sex were more likely to also report abuse, Wald (1, n = 773) = 9.02, p < .05, Odds Ratio (OR) = 1.61, Confidence Interval (CI) = 1.18–2.21. We discuss psychosocial issues faced by gay and bisexual men who experience intimate partner abuse as they may pertain to interventions among this group.     

Using Behavioral and Electrophysiological Measures to Assess the Effects of a Preventive Intervention: A Preliminary Study with Preschool-Aged Foster Children

The current study was designed to explore the use of behavioral (i.e., accuracy and reaction times) and electrophysiological measures (i.e., event-related potentials) to assess the impact of a family-based preventive intervention for preschool-aged, maltreated children in foster care. These measures were recorded during a computerized flanker task designed to assess cognitive control and response monitoring. The sample was recruited from a larger randomized efficacy trial of Multidimensional Treatment Foster Care for Preschoolers (MTFC-P) and included foster children assigned to the intervention condition (n = 10), foster children assigned to a services-as-usual comparison condition (n = 13), and low-income, nonmaltreated community children (n = 11). The children’s behavioral and electrophysiological performance on the task was generally consistent with previous research with adults and older children. There were no group differences on the behavioral measures of cognitive control or response monitoring. Notably, however, group differences were observed on the electrophysiological measures of response monitoring. Specifically, the foster children who received services as usual were significantly less responsive to performance feedback about errors than the foster children who received the intervention and the nonmaltreated children. Applications of this methodology and implications of the results for future prevention research are discussed.     

Indoor Environmental Differences between Inner City and Suburban Homes of Children with Asthma

We conducted this study to compare environmental exposures in suburban homes of children with asthma to exposures in inner city homes of children with asthma, to better understand important differences of indoor pollutant exposure that might contribute to increased asthma morbidity in the inner city. Indoor PM₁₀, PM_2.5, NO₂, O₃, and airborne and dust allergen levels were measured in the homes of 120 children with asthma, 100 living in inner city Baltimore and 20 living in the surrounding counties. Home conditions and health outcome measures were also compared. The inner city and suburban homes differed in ways that might affect airborne environmental exposures. The inner city homes had more cigarette smoking (67% vs. 5%, p < .001), signs of disrepair (77% vs. 5%, p < .001), and cockroach (64% vs. 0%, p < .001) and mouse (80% vs. 5%, p < .001) infestation. The inner city homes had higher geometric mean (GM) levels (p < .001) of PM₁₀ (47 vs. 18 μg/m³), PM_2.5 (34 vs. 8.7 μg/m³), NO₂ [19 ppb vs. below detection (BD)], and O₃ (1.9 vs. .015 ppb) than suburban homes. The inner city homes had lower GM bedroom dust allergen levels of dust mite (.29 vs. 1.2 μg/g, p = .022), dog (.38 vs. 5.5 μg/g, p < .001) and cat (.75 vs. 2.4 μg/g, p = .039), but higher levels of mouse (3.2 vs. .013 μg/g, p < .001) and cockroach (4.5 vs. .42 U/g, p < .001). The inner city homes also had higher GM airborne mouse allergen levels (.055 vs. .016 ng/m³, p = .002). Compared with the homes of suburban children with asthma, the homes of inner city Baltimore children with asthma had higher levels of airborne pollutants and home characteristics that predispose to greater asthma morbidity. Simons, Curtin-Brosnan, and Eggleston are with the The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Buckley and Breysse are with the The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Simons is with the Divisions of Allergy and Immunology, Albany Medical College, Albany, NY, USA.     

Efficacy of a Culturally Adapted Intervention for Youth Living with HIV in Uganda

This study examined whether a culturally adapted version of a previously evaluated efficacious HIV prevention program reduced sexual risk behaviors of youth living with HIV (YLH) in Uganda. YLH, 14 to 21 years, were randomized to intervention (N = 50) or control (N = 50) conditions. Significantly more YLH in the intervention used condoms consistently and decreased their number of sexual partners in comparison to the control condition. Western interventions can be culturally adapted to retain efficacy in reducing the sexual risk behavior of YLH. Source of Support: R01 DA-07903 from the National Institute on Drug Abuse.     

Parent Recruitment and Retention in a Universal Prevention Program for Child Behavior and Emotional Problems: Barriers to Research and Program Participation

Despite the potential of parent training as a prevention and behavioral family intervention strategy, there are a number of important issues related to implementation (e.g., recruitment and retention of families). This paper presents recruitment and retention data from families enrolling in a randomized controlled universal prevention trial for child behavior problems conducted in Germany. The recruitment rate averaged 31% (general project participation), with families of lower socioeconomic status (SES) participating at a lower rate. Project-declining families most often reported intrusion of privacy as their primary concern. In contrast, once parents were enrolled in the project, participation among those randomized to the parent training group averaged 77% (program/intervention participation); non-participation was mostly due to logistical issues. Parents accepting the offer of parent training were more likely to report child behavior problems than did declining parents. Although parents from more disadvantaged areas had a lower overall level of participation in the project once recruited, parents with children having higher levels of behavior problems indeed were more likely to participate in the intervention. Different recruitment methods may be required to engage high-risk families from socioeconomically disadvantaged areas to further improve community-level impact on child mental health.     

Association of Occupational and Substance Use Factors with Burnout among Urban Transit Operators

Burnout is a special type of prolonged occupational stress that is linked with numerous psychosomatic and psychological sequelae and negative job consequences. The purpose of this study is to estimate the contribution of occupational and substance use factors to burnout among a multiethnic sample of urban transit operators (n = 1231). Survey and medical exam data were obtained from participants in the 1993–1995 San Francisco MUNI Health & Safety Study. Burnout was measured with the Maslach Burnout Inventory emotional exhaustion subscale. Occupational factors included frequency of job problems (e.g., equipment, passengers, and traffic), years driving, full or part-time work status, and ergonomic problems (e.g., adjusting the seat, back support, vibration, and rocking or bouncing of seat). Substance use measures were alcohol consumption and smoking status (i.e., current, former, and never smokers). The results of multivariable linear regression analysis showed that job problems (beta = 0.426, p < 0.001), ergonomic problems (beta = 0.138, p < 0.001), and full-time work status (beta = 0.070, p < 0.01) were associated with burnout. Smoking was not significant, but alcohol consumption was positively associated with burnout (beta = 0.067, p < 0.01). Age was negatively correlated with burnout (beta = −0.106, p < 0.001), which may reflect a healthy worker effect. Because aspects of the psychosocial and physical work environments can be modified, the findings have important implications for the prevention of burnout among municipal transit operators.     

Health Status,Quality of Life,Residential Stability,Substance Use,and Health Care Utilization among Adults Applying to a Supportive Housing Program

Supportive housing, defined as subsidized housing in conjunction with site-based social services, may help improve the health and residential stability of highly disadvantaged individuals. This study examined changes in health status, quality of life, substance use, health care utilization, and residential stability among 112 homeless and vulnerably housed individuals who applied to a supportive housing program in Toronto, Canada, from December 2005 to June 2007. Follow-up interviews were conducted every 6 months for 18 months. Comparisons were made between individuals who were accepted into the program (intervention) and those who were wait-listed (usual care) using repeated-measures analyses. Individuals who were accepted into the housing program experienced significantly greater improvements in satisfaction with living situation compared with individuals in the usual care group (time, F _3,3,261 = 47.68, p < 0.01; group × time, F _3,3,261 = 14.60, p < 0.01). There were no significant differences in other quality of life measures, health status, health care utilization, or substance use between the two groups over time. Significant improvement in residential stability occurred over time, independent of assigned housing group (time, F _3,3,261 = 9.96, p < 0.01; group × time, F _3,3,261 = 1.74, p = 0.17). The ability to examine the effects of supportive housing on homeless individuals was limited by the small number of participants who were literally homeless at baseline and by the large number of participants who gained stable housing during the study period regardless of their assigned housing status. Nonetheless, this study shows that highly disadvantaged individuals with a high prevalence of poor physical and mental health and substance use can achieve stable housing.     

Adjustment among Mothers Reporting Same-Gender Sexual Partners: A Study of a Representative Population Sample from Quebec Province (Canada)

We examined the well-being of mothers and non-mothers reporting exclusive opposite-gender sexual partners (OG), same-gender sexual partners (SG), or both (BI) in a representative sample of 20,773 participants (11,034 women) 15-years-old or older from the population of Quebec province in Canada. Participants completed a self-administered questionnaire and SG and BI women (n = 179) were matched to a sample of OG women (n = 179) based on age, income, geographical area, and children (having at least one 18-year-old or younger biological or adopted child at home). We assessed social milieu variables, risk factors for health disorders, mental health, and quality of mothers’ relationship with children. The findings indicated a sexual orientation main effect: Mothers and non-mothers in the SG and BI group, as compared to their OG controls, were significantly less likely to live in a couple relationship, had significantly lower levels of social support, higher prevalence of early negative life events, substance abuse, suicide ideation, and higher levels of psychological distress. There were no Sexual Orientation X Parenthood status effects. The results further indicated that sexual orientation did not account for unique variance in women’s psychological distress beyond that afforded by their social milieu, health risk factors, and parenthood status. No significant differences were found for the quality of mothers’ relationship with children. SG-BI and OG mothers with low levels of social integration were significantly more likely to report problems with children than parents with high levels of social integration. We need to understand how marginal sexualities and their associated social stigma, as risk indicators for mothers, interact with other factors to impact family life, parenting skills, and children’s adjustment.     

Preventing College Women’s Sexual Victimization Through Parent Based Intervention: A Randomized Controlled Trial

A randomized controlled trial, using parent-based intervention (PBI) was designed to reduce the incidence of alcohol-involved sexual victimization among first-year college students. The PBI, adapted from Turrisi et al. (2001), was designed to increase alcohol-specific and general communication between mother and daughter. Female graduating high school seniors and their mothers were recruited from the community and randomly assigned to one of four conditions: Alcohol PBI (n = 305), Enhanced Alcohol + Sex PBI (n = 218), Control (n = 288) or Unmeasured Control (n = 167). Mothers in the intervention conditions were provided an informational handbook and encouraged to discuss its contents with their daughters prior to college matriculation. Consistent with hypotheses, PBI, either standard or enhanced, was associated with lower incidence of incapacitated rape in the first year of college relative to controls. Path analysis revealed support for a hypothesized indirect effects model, by which intervention increased mother-daughter communication, which predicted lower frequency of first semester heavy episodic drinking, resulting in lower rates of alcohol-involved sexual victimization in the first year of college.     

Enhancing Coparenting, Parenting, and Child Self-Regulation: Effects of Family Foundations 1 Year after Birth

This study investigated whether a psycho-educational program with modest dosage (eight sessions), delivered in a universal framework through childbirth education programs and targeting the coparenting relationship would have a positive impact on observed family interaction and child behavior at 6-month follow-up (child age 1 year). One hundred sixty-nine couples, randomized to intervention and control conditions, participated in videotaped family observation tasks at pretest (during pregnancy) and at child age 1 year (2003–2007). Coparenting, parenting, couple relationship, and child self-regulatory behaviors were coded by teams of raters. Intent-to-treat analyses of program effects controlled for age, education, and social desirability. Evidence of significant (p < 0.05) program effects at follow-up emerged in all four domains. Effect sizes ranged from 0.28 to 1.01. Targeting the coparenting relationship at the transition to parenthood represents an effective, non-stigmatizing means of promoting parenting quality and child adjustment. An erratum to this article can be found at