The Birds,Bees, and Special Needs: Making Evidence-Based Sex Education Accessible for Adolescents with Intellectual Disabilities

Adolescents with intellectual disabilities (ID) represent an invisible at-risk population for multiple negative health outcomes. Much like their non-disabled peers, promoting healthy behaviors during adolescence has the potential to improve quality of life later on in life (McPherson et al. in J Appl Res Intellect Disabil 30(2):360, 2017). Many studies have analyzed disparities in obesity (Phillips et al. in Matern Child Health J 18(8):1964, 2014; Stancliffe et al. in Am J Intellect Dev Disabil 116(6):401, 2011), mental health (Charlot and Beasley in J Ment Health Res Intellect Disabil 6(2):74, 2013), and health care access (Baller and Barry in J Disabil Policy Stud 27(3):148, 2016), however sexual health needs further research and translation to practice. Access to sexual health education is limited for many youth with ID (Barnard-Brak et al. in Ment Retard 52(2):85–97, 2014). Studies have shown that students with ID experience higher rates of sexual abuse and assault than their non-disabled peers (Haydon et al. in J Interpers Violence 26(17):3476, 2011; Mahoney and Poling in J Dev Phys Disabil 23(4):369, 2011). Sexually active youth with ID are at a higher risk for contracting sexually transmitted infections compared to their non-disabled peers (Cheng and Udry in J Dev Phys Disabil 17(2):155–172, 2005; Mandell et al. in J School Health 78(7):382–388, 2008). Additional barriers exist including stigma and misperceptions around disability and sexuality and the assumption that the developmental status of the student will prevent sex education comprehension (Sinclair et al. in Educ Train Autism Dev Disabil 50(1):3–16, 2015). Qualitative studies of adult providers (Linton et al. in Sex Disabil 34(2):145–156, 2016; Murphy et al. in J Genet Couns 25(3):552, 2016), parents (Kok and Akyuz in Sex Disabil 33(2):157–174, 2015), and adolescents with ID (Löfgren-Mårtenson in Sex Disabil 30(2):209–225, 2012) have found overwhelming support for tailored sexual risk reduction interventions (Swango-Wilson in Sex Disabil 27(4):223, 2009). Developing evidence-based, inclusive curricula to prevent sexual coercion as well as promote sexual health self-determination for this vulnerable population is long overdue (McDaniels and Fleming in Sex Disabil 34(2):215, 2016). This study demonstrates the use of Universal Design for Learning (UDL), an educational framework, guidelines, and checklist tools (Eagleton, Universal Design for Learning (UDL), Salem Press, Ipswich, 2015; Center for Applied Special Technology, UDL curriculum self-check 2011 (updated 2011), 2011. http://udlselfcheck.cast.org/resources.php) to increase accessibility in HIPTeens, an evidence-based sexual risk reduction intervention (Morrison-Beedy et al. in J Assoc Nurses AIDS Care 13(1):21–27, 2002; Res Nurs Health 28(1):3–15, 2005; AIDS Behav 10(5):541, 2006; J Assoc Nurses AIDS Care 21(2):153–161, 2010; West J Nurs Res 33(5):690–711, 2011; J Adolesc Health 52(3):314–321, 2013; J Assoc Nurses AIDS Care 28(6):877–887, 2017). As a result, supplemental curriculum components were developed with UDLguided technology use recommendations. A UDL-integrated evidence-based sexual risk reduction intervention could increase accessibility and, with additional research, could help inform inclusive policy.     

AFOMP policy number 6: code of ethics for medical physicists in AFOMP Countries

This policy statement, which is the sixth of a series of documents prepared by the Asia-Oceania Federation of Organizations for Medical Physics (AFOMP) Professional Development Committee, gives guidance on how medical physicists in AFOMP countries should conduct themselves in an ethical manner in their professional practice (Ng et al. in Australas Phys Eng Sci Med 32:175–179, 2009; Round et al. in Australas Phys Eng Sci Med 33:7–10, 2010; Round et al. in Australas Phys Eng Sci Med 34:303–307, 2011; Round et al. in Australas Phys Eng Sci Med 35:393–398, 2012; Round et al. in Australas Phys Eng Sci Med 38:217–221, 2015). It was developed after the ethics policies and codes of conducts of several medical physics societies and other professional organisations were studied. The policy was adopted at the Annual General Meeting of AFOMP held in Jaipur, India, in November 2017.     

The Importance of Sexuality Education for Children With and Without Intellectual Disabilities: What Parents Think

Individuals with intellectual and developmental disabilities (IDD) experience much higher rates of forced sexual interactions than non-disabled individuals, with incidence ranges from 44% in children (Ballan in J Autism Dev Disord 42:676–684, 2012; Kvam in Child Abuse Negl 24:1073–1084, 2000; van der Put et al. in J Intellect Disabil Res 58:979–991, 2014) to 83% in adults (Johnson and Sigler in J Fam Violence 15:95–108, 2000). These incidents may be perpetrated by others with disabilities (van der Put et al. in J Intellect Disabil Res 58:979–991, 2014) or, more frequently, by caregivers or others known to the individual. This may be the case because individuals with intellectual and developmental disabilities (IDD)—especially those with very low IQs—tend to receive little by way of sex education. This study assessed parental beliefs of sexuality education needs of children with and without disabilities through an online survey comprised of questions about the parents, their child, and their attitudes about their child’s sexuality. Results showed that parents of children with IDD are less likely to believe their children will have consensual or non-consensual sex before age 18 than parents of children without IDD, but favor sexuality education for their children, with parents preferring to provide it themselves, with the assistance of or through preparation by workshop with a professional. These finding are discussed in the context of implications for intervention and increasing options for sexuality education for learners with IDD.     

Medical ethics: enhanced or undermined by modes of payment?

Background

In the medical literature [1, 2, 7], the view prevails that any change away from fee-for-service (FFS) jeopardizes medical ethics, defined as motivational preference in this article. The objective of this contribution is to test this hypothesis by first developing two theoretical models of behavior, building on the pioneering works of Ellis and McGuire [4] and Pauly and Redisch [11]. Medical ethics is reflected by a parameter α, which indicates how much importance the physician attributes to patient well-being relative to his or her own income. Accordingly, a weakening of ethical orientation amounts to a fall in the value of α. While traditional economic theory takes preferences as predetermined, more recent contributions view them as endogenous (see, e.g., Frey and Oberholzer-Gee [5]).

Methods

The model variant based on Ellis and McGuire [4] depicts the behavior of a physician in private practice, while the one based on Pauly and Redisch [11] applies to providers who share resources such as in hospital or group practice. Two changes in the mode of payment are analyzed, one from FFS to prospective payment (PP), the other to pay-for-performance (P4P). One set of predictions relates physician effort to a change in the mode of payment; another, physician effort to a change in α, the parameter reflecting ethics. Using these two relationships, a change in ethics can observationally be related to a change in the mode of payment. The predictions derived from the models are pitted against several case studies from diverse countries.

Results

A shift from FFS to PP is predicted to give rise to a negative observed relationship between the medical ethics of physicians in private practice under a wide variety of circumstances, more so than a shift to P4P, which can even be seen as enhancing medical ethics, provided physician effort has a sufficiently high marginal effectiveness in terms of patient well-being. This prediction is confirmed to a considerable degree by circumstantial evidence coming from the case studies. As to physicians working in hospital or group practice, the prediction is again that a transition in hospital payment from FFS to PP weakens their ethical orientation. However, this prediction could not be tested because the one hospital study found relates to a transition to P4P, suggesting that this mode of payment may actually enhance medical ethics of healthcare providers working in a hospital or group practice.

Conclusion

The claim that moving away from FFS undermines medical ethics is far too sweeping. It can only in part be justified by observed relationships, which even may suggest that a transition to P4P strengthens medical ethics.

     

Sadistic Offender or Sexual Sadism? Taxometric Evidence for a Dimensional Structure of Sexual Sadism

Severe sexual sadism is a disorder of sexual preferences that focuses on humiliation and domination of the victim, sometimes causing grievous injury or death. Because offenders with high levels of sadism represent a risk to both reoffend and cause considerable harm should they reoffend, a diagnosis of sexual sadism has serious implications. The actual diagnosis of sexual sadism is fraught with problems (i.e., low reliability and validity) and exhibits poor consistency across assessments and studies (Levenson, 2004; Marshall, Kennedy, & Yates, 2002a). Various authors have proposed that sadism should be reconceptualized and have suggested that a dimensional approach may be more effective than a classificatory one for diagnosing sexual sadism (e.g., Marshall & Kennedy, 2003; Nietschke, Osterheider, & Mokros, 2009b). The dimension versus taxon question also impacts debates about the etiology and treatment of sadism. We assessed the taxonicity of sexual sadism by conducting a taxometric analysis of the scores of 474 sex offenders from penitentiary settings on the MTC Sexual Sadism Scale, using Meehl’s taxometric methods (Meehl & Yonce, 1994; Waller & Meehl, 1998). Findings indicated that sexual sadism presents a clear underlying dimensional structure. These results are consistent with earlier research supporting a dimensional assessment of sexual sadism and indicate that the diagnosis of sexual sadism should be reconceptualized. The theoretical and clinical implications of these findings are discussed.     

Is technology still a major driver of health expenditure in the United States? Evidence from cointegration analysis with multiple structural breaks

Using a longer span of available time series data and employing powerful unit root and cointegration tests that allow for multiple structural breaks, developed recently by Carrion-i-Silvestre et al. (Econ Theory 25:1754–1792, 2009), Perron and Yabu (J Bus Econ Stat 27:369–396, 2009), Kejriwal and Perron (J Econ 146(1):59–73, 2008; J Bus Econ Stat 28(4):503–522, 2010a; J Time Ser Anal 31:305–328, 2010b) and Maki (Econ Model 29:2011–2015, 2012), this paper empirically investigates, whether technology continues to be a major driver of real per capita health expenditure, along with some control variables such as per capita income and life expectancy, in the United States, during the period 1960–2012. Specifically, the paper applies the most recent cointegration tests under multiple structural breaks and extends the work of Okunade (J Health Econ 21(1):147–159, 2002) with the possibility whether a linear cointegration model with multiple structural breaks would provide a better economic model to quantify the impact of some major determinants of US real per capita health expenditure. This paper presents evidence to show that per capita real income, technology as indicated by four proxy measures and life expectancy at birth are some major drivers of real per capita health expenditure in the United States. Contrary to the available evidence in the literature, the finding of this paper is that the point aggregate income elasticity of health expenditure estimate is less than one, indicating that health care has evolved to become a necessity in the United States. Policy implications of the empirical findings are discussed in the paper.     

Global Self-Worth in Latino Youth: The Role of Acculturation and Acculturation Risk Factors

Background

Despite Latino youth being at increased risk of developing mental health problems, they are less likely to receive adequate treatment (Gonzales et al. in Handbook of U.S. Latino psychology: developmental and community-based perspectives. Sage, Thousand Oaks, pp 115–134, 2009; Romero et al. in Ethn Health 12(5):443–463, 2007; Smokowski et al. in J Community Psychol 37(8):1024–1045, 2009; Flores in Pediatrics 125(4):e979–e1020, 2010). Better understanding of the factors that influence psychosocial outcomes for Latino youth is crucial to addressing existing mental health disparities.

Objective

In order to build on existing knowledge of factors that promote positive mental health outcomes for Latino youth, the current study examined sociocultural influences on Latino early adolescents’ global self-worth. In particular, researchers investigated the effects of acculturation and acculturation risk factors on early adolescents’ perceptions of global self-worth.

Methods

Seventy-nine Latino early adolescents completed a series of questionnaires assessing behavioral and cognitive aspects of acculturation (i.e., ethnic culture of origin, US mainstream culture, and biculturalism), acculturation risk factors (i.e., acculturation stress, acculturation conflict, and perceived ethnic discrimination), and global self-worth.

Results

Results suggested that specific cultural orientations were associated with increased global self-worth, and increased levels of acculturation risk factors were associated with decreased global self-worth. Acculturation conflict was the most salient predictor of global self-worth, and regression analyses indicated that the effects of acculturation stress, acculturation conflict, and perceived ethnic discrimination on global self-worth depended on youth’s cultural orientation on the behavioral and cognitive measures of acculturation.

Conclusions

Results indicate the importance of assessing both cognitive and behavioral aspects of acculturation, as well as the way in which acculturation moderates the relation between acculturation risk factors and early adolescents’ perceptions of global self-worth.

     

Automated medical resident rotation and shift scheduling to ensure quality resident education and patient care

At academic teaching hospitals around the country, the majority of clinical care is provided by resident physicians. During their training, medical residents often rotate through various hospitals and/or medical services to maximize their education. Depending on the size of the training program, manually constructing such a rotation schedule can be cumbersome and time consuming. Further, rules governing allowable duty hours for residents have grown more restrictive in recent years (ACGME 2011), making day-to-day shift scheduling of residents more difficult (Connors et al., J Thorac Cardiovasc Surg 137:710–713, 2009; McCoy et al., May Clin Proc 86(3):192, 2011; Willis et al., J Surg Edu 66(4):216–221, 2009). These rules limit lengths of duty periods, allowable duty hours in a week, and rest periods, to name a few. In this paper, we present two integer programming models (IPs) with the goals of (1) creating feasible assignments of residents to rotations over a one-year period, and (2) constructing night and weekend call-shift schedules for the individual rotations. These models capture various duty-hour rules and constraints, provide the ability to test multiple what-if scenarios, and largely automate the process of schedule generation, solving these scheduling problems more effectively and efficiently compared to manual methods. Applying our models on data from a surgical residency program, we highlight the infeasibilities created by increased duty-hour restrictions placed on residents in conjunction with current scheduling paradigms.     

Consistent estimation of polychotomous treatment effects with selection-bias and unobserved heterogeneity using panel data correlated random coefficients model

We estimate multiple treatment effects in presence of selection-bias and response heterogeneity, using panel data. A control function was added to a fixed-effects based correlated random coefficients model. Selection model to create the control function was contrasted between multinomial logit and multinomial probit. For the multinomial logit model, parametric and semi-parametric bias correction techniques, as proposed in Lee (Econometrica 51(2):507–512, 1983), Dubin and McFadden (Econometrica 52(2):345–362, 1984) and Dahl (Econometrica 70(6):2367–2420, 2002) respectively, were implemented. We find that controlling time-varying endogeneity, allowing response heterogeneity, the type of bias correction method and the choice of the selection model, each had significant impact on the estimated treatment effects. Using the case of biologic DMARDs, we show that in the presence of heterogeneity and multiple treatments, the specification of the latent index model should be carefully chosen along with selection bias correction techniques appropriate to the choice of the latent index model. These issues have an important impact on policy. Under one set of assumptions, we may accept a formulary expansion policy on biologic DMARDs to be cost-neutral, while rejecting the same policy as not cost-saving under another set of assumptions.     

Participatory Budgeting: Could It Diminish Health Disparities in the United States?

Participatory budgeting (PB)—a democratic process where ordinary residents decide directly how to spend part of a public budget—has gained impressive momentum in US municipalities, spreading from one pilot project in Chicago’s 49th ward in 2009 to 50 active PB processes across 14 cities in 2016–2017. Over 93,600 US residents voted in a PB process in 2015–2016, deciding over a total of about $49.5 million and funding 264 projects intended to improve their communities. The vast majority of US PB processes take place in large urban centers (e.g., New York City, Chicago, Seattle, Boston), but PB has also recently spread to some smaller cities and towns [1]. Figure 1 illustrates the growth of PB processes in the USA, and within New York City and Chicago council districts specifically.

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Fig. 1 Participatory budgeting in the USA has grown from 1 process in 2009–2010 to 50 processes in 2016–2017

PB constitutes a rare form of public engagement in that it typically comprises several distinct stages that encourage residents to participate from project idea collection to project implementation (see Fig. 2). The decisive public vote in US PB is practically binding as elected officials commit to implementing the public decision at the outset of the process. Moreover, all current PB processes in the USA have expanded voting rights to residents under 18 years old and to non-citizens. Under President Obama, the White House recognized PB as a model for open governance. Participatory Budgeting Project, a nonprofit organization that advocates for PB, won the 2014 Brown Democracy Medal, which recognizes the best work being done to advance democracy in the USA and internationally.

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Fig. 2 Typical stages of a participatory budgeting process in the USA

PB has been lauded for its potential to energize local democracy, contribute to more equitable public spending and help reduce inequality [2, 3]. Social justice goals have been explicit in US PB from the start. Grassroots advocates, technical assistance providers, and many elected officials who have adopted it emphasize that PB must focus on engaging underrepresented and marginalized communities [2, 4, 5]. PB steering committees have specified equity and inclusiveness goals in PB rule books [6, 7]. The most conclusive research so far on PB’s potential to reduce social inequalities, however, comes from Brazil, where PB started in 1989. In Brazil, PB has been associated with a reduction in extreme poverty, better access to public services, greater spending on sanitation and health services, and, most notably, a reduction in child and infant mortality [8, 9].In this paper, we outline three mechanisms by which PB could affect health disparities in US municipalities: First, by strengthening residents’ psychological empowerment; second, by strengthening civic sector alliances; and third, by (re)distributing resources to areas of greatest need. We summarize the theoretical argument for these impacts, discuss the existent empirical evidence, and highlight promising avenues for further research.     

“Home Practice Is the Program”: Parents’ Practice of Program Skills as Predictors of Outcomes in the New Beginnings Program Effectiveness Trial

An examination of the content and processes of evidence-based programs is critical for empirically evaluating theories about how programs work, the “action theory” of the program (West et al. in American Journal of Community Psychology, 21, 571–605, 1993). The New Beginnings Program (NBP; Wolchik et al., 2007), a parenting-after-divorce preventive intervention, theorizes that program-induced improvements in parenting across three domains: positive relationship quality, effective discipline, and protecting children from interparental conflict, will reduce the negative outcomes that are common among children from divorced families. The process theory is that home practice of program skills related to these parenting domains is the primary mechanism leading to positive change in parenting. This theory was tested using multi-rater data from 477 parents in the intervention condition of an effectiveness trial of the NBP (Sandler et al. 2016a, 2016b). Four research questions were addressed: Does home practice of skills predict change in the associated parenting outcomes targeted by the program? Is the effect above and beyond the influence of attendance at program sessions? What indicators of home practice (i.e., attempts, fidelity, efficacy, and competence) are most predictive of improvements in parenting? Do these indicators predict parenting improvements in underserved subpopulations (i.e., fathers and Latinos)? Structural Equation Modeling analyses indicated that parent-reported efficacy and provider-rated parent competence of home practice predicted improvements in the targeted parenting domains according to both parent and child reports. Moreover, indicators of home practice predicted improvements in parenting for fathers and Latinos, although patterns of effects varied by parenting outcome.     

CASPer,an online pre-interview screen for personal/professional characteristics: prediction of national licensure scores

Typically, only a minority of applicants to health professional training are invited to interview. However, pre-interview measures of cognitive skills predict for national licensure scores (Gauer et al. in Med Educ Online 21 2016) and subsequently licensure scores predict for performance in practice (Tamblyn et al. in JAMA 288(23): 3019–3026, 2002; Tamblyn et al. in JAMA 298(9):993–1001, 2007). Assessment of personal and professional characteristics, with the same psychometric rigour of measures of cognitive abilities, are needed upstream in the selection to health profession training programs. To fill that need, Computer-based Assessment for Sampling Personal characteristics (CASPer)—an on-line, video-based screening test—was created. In this paper, we examine the correlation between CASPer and Canadian national licensure examination outcomes in 109 doctors who took CASPer at the time of selection to medical school. Specifically, CASPer scores were correlated against performance on cognitive and ‘non-cognitive’ subsections of both the Medical Council of Canada Qualifying Examination (MCCQE) Parts I (end of medical school) and Part II (18 months into specialty training). Unlike most national licensure exams, MCCQE has specific subcomponents examining personal/professional qualities, providing a unique opportunity for comparison. The results demonstrated moderate predictive validity of CASPer to national licensure outcomes of personal/professional characteristics three to six years after admission to medical school. These types of disattenuated correlations (r = 0.3–0.5) are not otherwise predicted by traditional screening measures. These data support the ability of a computer-based strategy to screen applicants in a feasible, reliable test, which has now demonstrated predictive validity, lending evidence of its validation for medical school applicant selection.     

Diet modeling in older Americans: The impact of increasing plant-based foods or dairy products on protein intake

Objectives

To determine the effects of increasing plant-based foods or dairy products on protein intake in older Americans by performing diet modeling.

Design

Data from What We Eat in America (WWEIA), the dietary component of the National Health and Nutrition Examination Survey (NHANES), 2007-2010 for Americans aged 51 years and older (n=5,389), divided as 51-70 years (n=3,513) and 71 years and older (n=1,876) were used.

Measurements

Usual protein intake was compared among three dietary models that increased intakes by 100%: (1) plant-based foods; (2) higher protein plant-based foods (i.e., legumes, nuts, seeds, soy); and (3) dairy products (milk, cheese, and yogurt). Models (1) and (2) had commensurate reductions in animal-based protein intake.

Results

Doubling intake of plant-based foods (as currently consumed) resulted in a drop of protein intake by approximately 22% for males and females aged 51+ years. For older males and females, aged 71+ years, doubling intake of plant-based foods (as currently consumed) resulted in an estimated usual intake of 0.83±0.02 g/kg ideal body weight (iBW))/day and 0.78±0.01 g/kg iBW/day, respectively. In this model, 33% of females aged 71+ years did not meet the estimated average requirement for protein. Doubling dairy product consumption achieved current protein intake recommendations.

Conclusion

These data illustrate that increasing plant-based foods and reducing animal-based products could have unintended consequences on protein intake of older Americans. Doubling dairy product intake can help older adults get to an intake level of approximately 1.2 g/kg iBW/day, consistent with the growing consensus that older adults need to consume higher levels of protein for health.

     

Nutritional and functional status in geriatric day hospital patients–MNA short form versus full MNA

Objectives

The aims of this study were to determine the prevalence of malnutrition in patients of a geriatric day hospital using the Mini Nutritional Assessment short form (MNA-SF) and the full MNA, to compare both tools, and to examine the relationship between nutritional and functional status.

Design

Cross-sectional study.

Setting

Geriatric day hospital.

Participants

190 patients (72.1% female, median 80 years) aged 65 years or older.

Measurements

In consecutively admitted geriatric day hospital patients nutritional status was assessed by MNA-SF and full MNA, and agreement between both tools calculated by Cohen’s kappa. Basic activities of daily living (ADL), instrumental activities of daily living (IADL) and short physical performance battery (SPPB) were determined and related to MNA categories (Chi²-test, Mann-Whitney-U-test).

Results

36.3 % and 44.7% of the patients were at risk of malnutrition, 8.9 % and 5.8 % were malnourished according to MNA-SF and full MNA, respectively. Agreement between both MNA forms was moderate (?=0.531). No significant associations between MNA-SF and ADL, IADL and SPPB, and between full MNA and SPPB were observed. According to full MNA, the proportion of patients with limitations in ADL and IADL significantly increased with declining nutritional status (ADL: 2.1 vs. 8.2 vs. 18.2 %, p=0.044; IADL: 25.5 vs. 47.1 vs. 54.5 %, p=0.005) with a simultaneous decrease of the proportion of patients without limitations. Well-nourished patients reached significantly higher ADL scores than patients at risk of malnutrition (95 (-100) vs. 95 (85- 100), p=0.005) and significantly higher IADL scores than patients at risk or malnourished (8 (6-8) vs. 7 (5-8) vs. 6 (4-8), p=0.004).

Conclusion

The high prevalence of risk of malnutrition and the observed association between functional status and nutritional status according to full MNA call for routine nutritional screening using this tool in geriatric day hospital patients.

     

Threshold analysis in the presence of both the diagnostic and the therapeutic risk

The well-established a priori probability of illness threshold in medical decision making, introduced by Pauker and Kassirer (N Engl J Med 293:229–234, 1975; N Engl J Med 302:1109–1117, 1980), involves the diagnostic risk only. We generalize the threshold analysis by adding the therapeutic risk, i.e., in accounting for the risk that a treatment might sometimes fail. We derive a priori probability of illness threshold as a function of the probability of successful treatment, as well as the inverted function, where the successful treatment probability threshold is a function of the a priori probability of illness. The thresholds in the general model are higher than those in the special cases where one of the two risks is absent. Applications show that the changes in the thresholds can be substantial. Our general model might explain empirical findings of much higher thresholds than the Pauker–Kassirer model suggests.     

Item bias detection in the Hospital Anxiety and Depression Scale using structural equation modeling: comparison with other item bias detection methods

Purpose

Comparison of patient-reported outcomes may be invalidated by the occurrence of item bias, also known as differential item functioning. We show two ways of using structural equation modeling (SEM) to detect item bias: (1) multigroup SEM, which enables the detection of both uniform and nonuniform bias, and (2) multidimensional SEM, which enables the investigation of item bias with respect to several variables simultaneously.

Method

Gender- and age-related bias in the items of the Hospital Anxiety and Depression Scale (HADS; Zigmond and Snaith in Acta Psychiatr Scand 67:361–370, 1983) from a sample of 1068 patients was investigated using the multigroup SEM approach and the multidimensional SEM approach. Results were compared to the results of the ordinal logistic regression, item response theory, and contingency tables methods reported by Cameron et al. (Qual Life Res 23:2883–2888, 2014).

Results

Both SEM approaches identified two items with gender-related bias and two items with age-related bias in the Anxiety subscale, and four items with age-related bias in the Depression subscale. Results from the SEM approaches generally agreed with the results of Cameron et al., although the SEM approaches identified more items as biased.

Conclusion

SEM provides a flexible tool for the investigation of item bias in health-related questionnaires. Multidimensional SEM has practical and statistical advantages over multigroup SEM, and over other item bias detection methods, as it enables item bias detection with respect to multiple variables, of various measurement levels, and with more statistical power, ultimately providing more valid comparisons of patients’ well-being in both research and clinical practice.

     

The Associations Among Sibling and Peer-Bullying,Social Support and Internalizing Behaviors

Background

Peer bullying is associated with internalizing problems for children and adolescents. However, less is known about how these same behaviors are related to student well-being when they occur within the context of the sibling relationship and how supportive behavior may benefit those experiencing bullying.

Objective

The purpose of this study was to examine the unique associations among peer and sibling bullying and internalizing problems, and the role of peer and sibling social support in relation to social-emotional outcomes.

Methods

Data on students’ experiences of peer and sibling bullying, perceptions of social support and internalizing symptoms were collected from a sample of 372 elementary school students using the Revised Olweus Bully/Victim Questionnaire (OBVQ; Olweus 1996), a modified version of the OBVQ created to assess bullying by siblings, the Child and Adolescent Social Support Scale (CASSS; Malecki et al. 2000), and three subscales from the Behavior Assessment System for Children, Second Edition, Self-Report of Personality (Reynolds and Kamphaus 2004).

Results

Results indicated that Sibling Bullying was significantly related to internalizing problems above and beyond Peer Bullying alone. Additionally, social support from peers moderated the association between Sibling Bullying and Depression; and social support from siblings moderated the association between Peer Bullying and Social Stress. Gender differences in study findings were also uncovered.

Conclusions

Results of this study suggest that bullying behaviors are detrimental to student social-emotional well-being, regardless of whom the perpetrator may be, and that being bullied by siblings is associated with similar outcomes as traditional bullying.

     

The SOS Suicide Prevention Program: Further Evidence of Efficacy and Effectiveness

This study replicated and extended previous evaluations of the Signs of Suicide (SOS) prevention program in a high school population using a more rigorous pre-test post-test randomized control design than used in previous SOS evaluations in high schools (Aseltine and DeMartino 2004; Aseltine et al. 2007). SOS was presented to an ethnically diverse group of ninth grade students in technical high schools in Connecticut. After controlling for the pre-test reports of suicide behaviors, exposure to the SOS program was associated with significantly fewer self-reported suicide attempts in the 3 months following the program. Ninth grade students in the intervention group were approximately 64 % less likely to report a suicide attempt in the past 3 months compared with students in the control group. Similarly, exposure to the SOS program resulted in greater knowledge of depression and suicide and more favorable attitudes toward (1) intervening with friends who may be exhibiting signs of suicidal intent and (2) getting help for themselves if they were depressed or suicidal. In addition, high-risk SOS participants, defined as those with a lifetime history of suicide attempt, were significantly less likely to report planning a suicide in the 3 months following the program compared to lower-risk participants. Differential attrition is the most serious limitation of the study; participants in the intervention group who reported a suicide attempt in the previous 3 months at baseline were more likely to be missing at post-test than their counterparts in the control group.