Online social connections and Internet use among people with intellectual disabilities in the United Kingdom during the COVID-19 pandemic.

Having a disability, in particular, an intellectual disability, is associated with Internet non-use. This article explores how people with intellectual disabilities used the Internet across the United Kingdom during the COVID-19 pandemic. In April to May 2021, 571 adults with intellectual disabilities were interviewed. Participants most commonly used the Internet for being with family and friends, social media or doing online activities with other people. People who lived with family were the most likely to use social media; people who lived with other people with intellectual disabilities were the least likely. People who self-reported as not lonely were more likely to use the Internet for online activities with others and play video games with others. Social connections were identified as the best thing about the Internet. Many participants chose not to identify a worst thing about Internet use, while others reported issues with technology, online harm and threats to well-being.

Exploring the effects of socio-economic inequalities on health and disability in Northern Irish adolescents: evidence from a nationally representative longitudinal study.

Although a negative association between socio-economic inequalities and health has been established, there is a dearth of robust longitudinal studies examining this relationship in adolescents. This study used a large, nationally representative longitudinal data set to investigate the association between socio-economic inequality, subjective health status and disabilities among young people in Northern Ireland over a ten-year period. Data were from the Northern Ireland Longitudinal Study, a census-based record linkage study (N = 46,535). Logistic regression models were estimated in which health and disability variables from the 2011 census were predicted by household deprivation in education, housing quality, housing tenure and employment from the 2001 census. Models were adjusted for health and disability status in 2001. Deprivation in employment, housing tenure and coming from a single-parent household in 2001 independently predicted poorer subjective health and disability status ten years later [ORs = 1.28-1.93]. Deprivation in education in 2001 was also associated with increased risk of disability in 2011 [OR = 1.15; 95% CI = 1.06-1.25]. These results show that there is a need to dedicate more resources and support for economically disadvantaged children and young people in Northern Ireland, where child health outcomes are poorer than in the rest of the UK.

Bullying Reporting Concerns as a Mediator Between School Climate and Bullying Victimization/Aggression.

This study aimed to examine whether bullying reporting concerns mediate the relationship between school climate and student bullying victimization as well as aggressive behavior. Data were from a sample of 301 students in Grades 6 to 8 in two minority-predominant schools in a large U.S. metropolitan area. Findings from bootstrapped structural equation modeling (SEM) analyses indicated that for male students, a higher level of perceived anti-bullying school climate was negatively associated with bullying reporting concerns, while the reporting concerns subsequently were positively associated with bullying victimization and aggressive behavior. For female students, perceived school climate was not associated with bullying reporting concerns, but the latter were also positively associated with bullying victimization and aggressive behavior. Therefore, bullying reporting concerns mediated the association between perceived school climate and bullying victimization as well as aggressive behavior for male but not female students. The findings suggest the importance of strengthening anti-bullying school climate to help students overcome bullying reporting concerns to achieve effective outcomes. The gender difference of associations between school climate and bullying reporting concerns may reflect the variation of bullying types experienced by male and female students, which calls for attention to the development of anti-bullying strategies that take into account gender differences and address various types of bullying.

Challenges to conducting randomised controlled trials with adults with intellectual disabilities: Experiences of international experts.

BACKGROUND: Globally, conducting randomised controlled trials can be a complex endeavour. The complexity increases when including participants with cognitive or intellectual disabilities. A fuller understanding of the barriers and challenges that can be expected in such trials may help researchers to make their trials more inclusive for people with disabilities. METHOD: Semi-structured interviews were conducted with twelve international trial experts. RESULTS: Eight themes emerged relating to challenges linked to: 1) participant co-morbidities, 2) participant ability levels, 3) ethics and consent, 4) the RCT methodology, 5) gatekeeping, 6) staff turnover, 7) lack of technical understanding and 8) attitudes and perceptions. CONCLUSION: Conducting trials with cognitively disabled participants can pose unique challenges although many can be overcome with 'reasonable adjustments'. Challenges that are harder to overcome are attitudes and perceptions that people (professional staff, funding bodies, carers or fellow researchers) hold towards the utility of conducting trials with cognitively disabled populations.

Using a Delphi survey to gain an international consensus on the challenges of conducting trials with adults with intellectual disabilities.

BACKGROUND/AIMS: People with intellectual disability experience higher rates of multi-morbidity and health inequalities, they are frequently prescribed medications and more likely to have an avoidable or premature death. There is a recognised lack of randomised controlled trials, and subsequently a lack of evidence base, for many of the interventions and treatments provided to people with intellectual disabilities. Very few disability-specific trials are conducted, and people with intellectual, and other cognitive, disabilities are routinely excluded from mainstream trials. There is an urgent need to facilitate more disability-specific trials or to encourage mainstream trialists to include people with disabilities in their studies. Obtaining a thorough understanding of the challenges inherent in these trials, and sharing this knowledge within the research community, may contribute significantly towards addressing this need. The aim of this study was to explore the practical and methodological challenges to conducting trials with adults with intellectual disabilities and to reach a consensus regarding which are the most important challenges for researchers for inclusion in a resource toolkit. METHODS: A three-round modified Delphi survey was conducted with a panel of international trials researchers within the intellectual disability field. Items were assessed in terms of the consensus level and stability of responses. RESULTS: A total of 64 challenges and barriers were agreed upon, across all aspects of the trial pathway, from planning through to reporting. Some challenges and barriers had been noted in the literature previously, but many previously uncited barriers (both systemic and attitudinal) were identified. CONCLUSION: This is the first international survey exploring the experiences of researchers conducting randomised controlled trials with adults with intellectual disabilities. Many of the barriers and challenges reported can be overcome with creativity and some additional resources. Other challenges, including attitudes towards conducting trials with disabled populations, maybe harder to overcome. These findings have implications for conducting trials with other populations with cognitive or communication difficulties. Implications for disability researchers, funding bodies and ethical review panels are discussed.

A systematic review of the methodological and practical challenges of undertaking randomised-controlled trials with cognitive disability populations.

Approximately 10% of the world's population have a cognitive disability. Cognitive disabilities can have a profound impact on a person's social, cognitive or mental functioning, requiring high levels of costly health and social support. Therefore, it is imperative that interventions and services received are based upon a sound evidence-base. For many interventions for this population, this evidence-base does not yet exist and there is a need for more Randomised Controlled Trials (RCTs). The process of conducting RCTs with disabled populations is fraught with methodological challenges. We need a better understanding of these methodological barriers if the evidence-bases are to be developed. The purpose of this study was to explore the methodological and practical barriers to conducting trials with adults with cognitive disabilities. As a case example, the literature regarding RCTs for people with intellectual disabilities (ID) was used to highlight these pertinent issues. A systematic literature review was conducted of RCTs with adults with ID, published from 2000 to 2017. A total of 53 papers met the inclusion criteria and were reviewed. Some of the barriers reported were specific to the RCT methodology and others specific to people with disabilities. Notable barriers included; difficulties recruiting; obtaining consent; resistance to the use of control groups; engaging with carers, staff and stakeholders; the need to adapt interventions and resources to be disability-accessible; and staff turnover. Conducting RCTs with people with cognitive disabilities can be challenging, however with reasonable adjustments, many of these barriers can be overcome. Researchers are not maximising the sharing of their experience-base. As a result, the development of evidence-bases remains slow and the health inequities of people with disabilities will continue to grow. The importance of the MRC guidelines on process evaluations, together with implications for the dissemination of 'evidence-base' and 'experience-base' are discussed.

Providers' Perspectives on Case Management of a Healthy Start Program: A Qualitative Study.

Although Healthy Start case managers recognized the benefits of case management for facilitating optimal service delivery to women and their families, structural factors impact effective implementation. This study investigated case managers' views of 1) the structural challenges faced in implementing case management for program participants, and 2) possible strategies to enhance case management in medical home settings. Two focus groups were conducted separately with case managers from the four program service sites to gain insight into these issues noted above. Each group was co-facilitated by two evaluators using a previously developed semi-structured interview guide. The group discussions were audio recorded and the case managers' comments were transcribed verbatim. Transcripts were analyzed using thematic analysis, a deductive approach. Data were collected in 2013 and analyzed in 2015. Case managers are challenged by externalities (demographic shifts in target populations, poverty); contractual requirements (predefined catchment neighborhoods, caseload); limited support (client incentives, tailored training, and a high staff turnover rate); and logistic difficulties (organizational issues). Their approach to case management tends to be focused on linking Although Healthy Start case managers recognized the benefits of case management for facilitating optimal service delivery to women and their families, structural factors impact effective implementation. This study investigated case managers' views of 1) the structural challenges faced in implementing case management for program participants, and 2) possible strategies to enhance case management in medical home settings. Two focus groups were conducted separately with case managers from the four program service sites to gain insight into these issues noted above. Each group was co-facilitated by two evaluators using a previously developed semi-structured interview guide. The group discussions were audio recorded and the case managers' comments were transcribed verbatim. Transcripts were analyzed using thematic analysis, a deductive approach. Data were collected in 2013 and analyzed in 2015. Case managers are challenged by externalities (demographic shifts in target populations, poverty); contractual requirements (predefined catchment neighborhoods, caseload); limited support (client incentives, tailored training, and a high staff turnover rate); and logistic difficulties (organizational issues). Their approach to case management tends to be focused on linking clients to adequate services rather than reporting performance. Case managers favored measurable deliverables rather than operational work products. A proposed solution to current challenges emphasizes and encourages the iterative learning process and shared decision making between program targets, funders and providers. Case managers are aware of the challenging environment in which they operate for their clients and for themselves. However, future interventions will require clearly identified performance measures and increased systems support.

Evaluation of an authority innovation-decision: brief alcohol intervention for pregnant women receiving women, infants, and children services at two Illinois health departments.

Despite the availability of clinical tools and evidence-based screening recommendations, there has been little discussion regarding screening of prenatal alcohol exposure in community-based settings, including adoption and implementation. This study's aim is to evaluate and validate--through surveys and focus groups--obstacles and challenges that shape efficacious implementation of the BAI at two Illinois health departments. Results suggest that BAI implementation is facilitated by staff perceptions of its benefits, readiness to implement the intervention, and organizational support for it. Limitations of the management information system, ambiguous screening questions, and high case-loads present barriers to effective BAI implementation.

Early adolescent participation in physical activity: correlates with individual and family characteristics.

BACKGROUND: Early adolescence is developmental period when youth begin to shift exercise and physical activity patterns toward increased sedentary living. The major causes and contributing factors to this change are poorly understood. This study examines the relationship between sociodemographic factors, behavioral and family factors that influence physical activity patterns of middle grades students. METHODS: The 1578 youth ranged in age from 12 (22%) to 13 (78%) and were divided between white (65%), African American (19%), and Hispanic (16%) subpopulations, with 37% overall qualifying for reduced-price or free school lunches. The assumptions for Analysis of Covariance versus Analysis of Variance (ANOVA) were examined, with the final results reported separately for attitudes toward exercise as predictors and sociodemographic variables and measures of family functioning as predictors. RESULTS: Positive attitudes were more strongly associated than were negative attitudes with exercise. Of the categorical predictors, student gender and family involvement with fitness had the most statistically significant associations with self reported exercise (6 for gender and 5 for family involvement with fitness). CONCLUSIONS: The results of this analysis of a diverse and large sample of young adolescents are placed in the context of family leisure and work time in our "hurried" culture.

Mobilizing communities for teen pregnancy prevention: associations between coalition characteristics and perceived accomplishments.

PURPOSE: To describe coalition membership, examine associations between coalition processes and short-term coalition outcomes, and assess the relative contribution of key coalition processes to perceived accomplishments in teen pregnancy prevention coalitions. METHODS: A self-administered survey was distributed to active members of 21 teen pregnancy prevention coalitions in 13 communities. The overall response rate was 67%, with 471 surveys returned. Process measures included staff competence, member influence in decision making, and coalition functioning. Short-term outcome measures included perceived accomplishments, member satisfaction, member participation, and coalition viability. RESULTS: About 50% of coalition members represented health or teen pregnancy prevention or youth development service organizations, with 13% participating primarily as residents or youth. None of the process measures were associated with coalition viability (defined as active 2 years post-survey). Many bivariate associations between coalition processes and other short-term outcomes were significant at the individual and coalition levels of analysis. In a multivariate random coefficients model, coalition functioning (p <.001) and member influence in decision making (p = .019) were significantly associated with perceived coalition accomplishments. CONCLUSION: Consistent with research on coalitions that have addressed other health issues, good coalition processes were associated with short-term indicators of effectiveness in these teen pregnancy prevention coalitions. Coalition processes were not associated with coalition viability 2 years post-survey, however, suggesting that other factors influence coalition survival.

Where public school students in Illinois get cigarettes and alcohol: characteristics of minors who use different sources.

The current study examined demographic, behavior, belief, and social influence characteristics of adolescents who use various means to get cigarettes and alcohol. Spring 1998 survey participants were 7302 6th, 8th, and 10th grade public school students from throughout Illinois, who self-identified as tobacco smokers and/or alcohol drinkers. The sample was not random, but closely matched the demographic composition of the state. Logistic regression analysis was used to examine the effect of each independent variable on each of the cigarette sources and each of the alcohol sources. For both cigarettes and alcohol, adolescents used commercial sources far less than they did social sources such as family and friends. Also, older adolescents and those who are heavier and more entrenched smokers or drinkers were more likely to use both commercial and social sources. Other factors related to use of various sources included beliefs, social influences, and environmental influences. These findings have many implications for intervention, especially by parents and policymakers, and suggest an increased emphasis on social sources adolescents use to obtain cigarettes and alcohol.

The influence of teacher support on student adjustment in the middle school years: a latent growth curve study.

The influence of perceived teacher support on trajectories of depression and self-esteem in middle school was examined using multigroup latent growth cross-domain models. A longitudinal sample of 2,585 students was followed from the sixth through the eighth grades. Students' perceptions of teacher support and general self-esteem declined and depressive symptoms increased over the course of middle school. We further found that, for both boys and girls, changes in perceptions of teachers' support reliably predicted changes in both self-esteem and depression. In particular, those students perceiving increasing teacher support showed corresponding decreases in depressive symptoms and increases in self-esteem. Gender differences were found for the initial levels of both perceptions of teacher support and general self-esteem. A competing model was also tested, which gave additional support for pathways of influence from perceptions of teacher support to depression and self-esteem, rather than the reverse. This study underscores the role of teacher support in facilitating students' adjustment to middle school and highlights the importance of using idiographic methodologies in the study of developmental processes. Implications and future directions are discussed.

Adolescents carrying handguns and taking them to school: psychosocial correlates among public school students in Illinois.

The current study sought to examine psychosocial correlates of adolescents carrying a handgun and taking a handgun to school. Survey participants were approximately 22,000 6th, 8th, and 10th grade public school students from throughout Illinois. Results showed that the strongest correlates of handgun carrying behaviours were variables directly associated with handguns and violence, both behaviours and beliefs, as well as delinquency variables. These findings have many implications for intervention by parents, schools, and policy makers to reduce the incidence of adolescent handgun carrying and taking a handgun to school.