Trauma Recovery Rubric: A Mixed-Method Analysis of Trauma Recovery Pathways in Four Countries.

Research is beginning to examine gender-based violence (GBV) survivors' recovery, but little is known about diverse recovery trajectories or their relationships with other distress and recovery variables. This interdisciplinary, international multisite mixed-method study developed and used the TRR to identify and classify survivors' trauma pathways. This study describes the phases of the initial development of the preliminary TRR (Phase 1), refines and calibrates the TRR (Phase 2), and then integrates the TRR into quantitative data from four countries (Phase 3). Seven recovery pathways with six domains emerged: normalizing, minimizing, consumed/trapped; shutdown or frozen, surviving, seeking and fighting for integration; finding integration/equanimity. Depression scores were related to most recovery domains, and TRR scores had large effect sizes. At the same time, PTSD was not statistically related to TRR scores, but TRR had a medium effect size. Our study found that the TRR can be implemented in diverse cultural settings and promises a reliable cross-cultural tool. The TRR is a survivor-centered, trauma-informed way to understand different survivorship pathways and how different pathways impact health outcomes. Overall, this rubric provides a foundation for future study on differences in survivor healing and the drivers of these differences. This tool can potentially improve survivor care delivery and our understanding of how to meet best the needs of the survivor populations we intend to serve.

Social Capital, Perceived Economic Affluence, and Smoking During Adolescence: A Cross-Sectional Study.

BACKGROUND: Smoking is among the health risk behaviors taken up by many adolescents with lifelong consequences and associations with multiple health risk behaviors. Smoking and smoking initiation in adolescence involves an interaction between micro-, meso-, and macro systems, including neighborhoods and the greater community. OBJECTIVES: To examine the associations of individual social and economic capital with self-reported health, life satisfaction, and smoking behavior in adolescents. METHODS: Using a multistage random sampling of junior high school students (16-18 years old) in Crete, Greece, 703 adolescents (90.2% 16 years old; 55.6% girls, participation rate 84.2%) completed an anonymous questionnaire based on HBSC study and the Youth Social Capital Scale (YSCS) during April-June 2008. Multiple logistic regression models were performed adjusted for potential confounders. RESULTS: Adolescents with high participation in their neighborhoods and communities (higher structural social capital) displayed lower odds for daily smoking; those feeling unsafe (lower cognitive social capital) were at greater odds of daily smoking. Adolescents with less friends and acquaintances had lower odds of having tried tobacco products. Smoking was not related to any economic capital variables (perceived affluence, paternal and maternal employment status). Adolescents with low/medium versus high total social capital were at higher odds for low life satisfaction and fair/bad versus excellent self-rated health. Conclusions/Importance: Social capital theory may provide a better understanding in identifying the social context that is protective or harmful to adolescents' smoking. Public health organizations at all levels need to incorporate social capital theory in their interventions.

Adolescent drinking, academic achievement and leisure time use by secondary education students in a rural area of Crete.

This study investigated the alcohol consumption of secondary education students and their relationship to school life and leisure time use with peers. A cross-sectional survey was conducted in March 2007, and the study population consisted of 14- to 19-year-old students living in an agricultural area of Crete. The final sample consisted of 117 individuals (response rate 90.0%). A short previously validated self-completion questionnaire was used collecting information on: personal and family characteristics; school progress; leisure time activities and relations with other adolescents; and alcohol consumption. Alcohol consumption differed significantly between male (75.5%) and female (25.8%) students (P < 0.001). Almost half of the participants (48.3%) reported alcohol consumption during nights out with friends. The mean grade for the previous year for students consuming alcohol was lower compared with those who did not, but the difference was not statistically significant (P = 0.066). Statistical evidence supported the hypothesis that students who consumed alcohol had more absences and this association was stronger for male students. The frequency of alcohol consumption was found to relate to the number of absences for both sexes. Male students who had been suspended from school were more likely to drink alcohol than those who had not been suspended. Statistical evidence also supported the hypotheses that students who spent their free time in cafeterias, bars or billiard halls were more likely to drink alcohol and also consume alcohol at higher frequencies than those that did not spend their free time this way (P = 0.002 and P < 0.001, respectively). More health education programmes and actions are needed at the national and local level to help students, families, schools, communities and the state better understand the real dimensions of the problem.